Cardiac abnormalities involvement

It is used as a sexual stimulant and is an ingredient in some wart removal remedies [13]. Poisoning is noteworthy for its dramatic effect on the gastrointestinal and urinary tracts, as well as occasionally inducing cardiac abnormalities and seizures [12, 13]. The patient may present with massive hematemesis and hematuria. The kidney is often involved with ATN and glomerular damage. Treatment is supportive and includes dialysis when indicated. 

Additional acute toxic symptoms involve cardiac abnormalities, liver dysfunction, and kidney inflammation. Agitated psychotic behavior can occur. For additional information, refer to Effects of Exposure to Toxic Gases-First Aid and Medical Treatment and Medical Management Guidelines for Acute Chemical Exposures [1,2]. 

Extra-articular involvement may include rheumatoid nodules, vasculitis, pleural effusions, pulmonary fibrosis, ocular manifestations, pericarditis, cardiac conduction abnormalities, bone marrow suppression, and lym-phadenopathy. 

Inhalation of certain hydrocarbons, including some anesthetics, can make the mammalian heart abnormally sensitive to epinephrine, resulting in ventricular arrhythmias, which in some cases can lead to sudden death (Reinhardt et al. 1971). The mechanism of action of cardiac sensitization is not completely understood but appears to involve a disturbance in the normal conduction of the electrical impulse through the heart, probably by producing a local disturbance in the electrical potential across cell membranes. The hydrocarbons themselves do not produce arrhythmia the arrhythmia is the result of the potentiation of endogenous epinephrine (adrenalin) by the hydrocarbon. 

Parenteral.Hyperkalemia Adverse reactions involve the possibility of potassium intoxication. Signs and symptoms include paresthesias of extremities flaccid paralysis muscle or respiratory paralysis areflexia weakness listlessness mental confusion weakness and heaviness of legs hypotension cardiac arrhythmias heart block ECG abnormalities such as disappearance of P waves, spreading and slurring of the QRS complex with development of a biphasic curve and cardiac arrest. 

Direct effects on the heart are determined largely by Bi receptors, although B2 and to a lesser extent a receptors are also involved, especially in heart failure. Beta-receptor activation results in increased calcium influx in cardiac cells. This has both electrical and mechanical consequences. Pacemaker activity—both normal (sinoatrial node) and abnormal (eg, Purkinje fibers)—is increased (positive chronotropic effect). Conduction velocity in the atrioventricular node is increased (positive dromotropic effect), and the refractory period is decreased. Intrinsic contractility is increased (positive inotropic effect), and relaxation is accelerated. As a result, the twitch response of isolated cardiac muscle is increased in tension but abbreviated in duration. In the intact heart, intraventricular pressure rises and falls more rapidly, and ejection time is decreased. These direct effects are easily demonstrated in the absence of reflexes evoked by changes in blood pressure, eg, in isolated myocardial preparations and in patients with ganglionic blockade. In the presence of normal reflex activity, the direct effects on heart rate may be dominated by a reflex response to blood pressure changes. Physiologic stimulation of the heart by catecholamines tends to increase coronary blood flow. 

Sodium and potassium are not the only ions which can participate in pumps and channels. Calcium is also pumped, channeled, exhanged,and stored. See Figure 23. Calcium concentration within the cell cytoplasm is very low. This allows the calcium to play a pivotal role in cellular activity. The cytoplasmic protein calmodulin binds and stores calcium ion. Various intracellular structures and organelles such as the mitochondria and sarcoplasmic reticulum also store calcium. Calcium is vital to such functions as the release of neurotransmitters from nerve cells. There are at least seven known modes of biochemical action for this ion, one of the most important of which involves stimulation of cardiac muscle protein (actin-myosin). Certain types of angina (heart pain) are believed to be caused by abnormal stimulation of cardiac arteries and muscle (coronary spasm) A relatively new class of drugs, known as the calcium channel blockers, has brought relief from pain and arrhythmias (irregular heart beats). 

Vitamin F, substances are necessary for the normal growth of animals. Without vitamin E, the animals develop infertility, abnormalities of the central nervous system, and myopathies involving both skeletal and cardiac muscle. The antioxidant activity of the tocopherols is in reverse order to that of their vitamin activity. Muscular tissue taken from a deficient... 

Pre-existing cardiac conduction abnormalities, including those induced by other drugs, are a definite risk. Due consideration should be given not only to the half-life of such drugs, but also to the tissue concentrations and total clearances of the agents involved. 

---