Chronic obstructive pulmonary disease arrhythmia

Albuterol Selective B2 agonist Prompt, efficacious bronchodilation Asthma, chronic obstructive pulmonary disease (COPD) drug of choice in acute asthmatic bronchospasm Aerosol inhalation duration several hours also available for nebulizer and parenteral use Toxicity. Tremor, tachycardia t overdose arrhythmias... 

Nonselective beta blockers affect beta-2 receptors on the lungs as well as beta-1 receptors on the heart, and these nonselective agents can increase bronchocon-striction in patients with asthma and chronic obstructive pulmonary disease. Hence, a drug that is more specific for beta-1 receptors is preferred in these patients. Beta blockers can also produce excessive slowing of cardiac conduction in some patients, resulting in an increase in arrhythmias. Severe adverse reactions are rare, however, and beta blockers are well-tolerated by most patients when used appropriately to treat arrhythmias. 

Atrial fibrillation is a relatively frequent supraventricular arrhythmia (10-12% of cases) (Figure 4.16 Sugiura et al, 1985), as other supraventricular arrhythmias are typically related to atrial involvement (Liu, Greenspan and Piccirillo, 1961 Zimerman, 1968) and/or pericarditis. Atrial fibrillation occurs usually in the most extensive ACSs. However, in patients with ACS due to RCA occlusion, it may be explained by vagal overdrive and maybe accompanied by AV block. Age, presence of abnormal P wave (Agarwal, 2003), chronic obstructive pulmonary disease (COPD) and heart failure are triggering factors. The incidence of atrial fibrillation has decreased in the post-thrombolytic era. 

Isoproterenol, a sympathomimetic amine with bronchodi-lating and cardiac stimulant properties, is indicated in the treatment of complete heart block, after closnre of ventricular septal defect, to prevent heart block, as maintenance therapy in AV block, as treatment of bronchospasm dnring mild acute asthma attacks, bronchospasm in chronic obstructive pulmonary disease, bronchospasm dnring mild acute asthma attacks or in chronic obstrnctive pnhnonary disease, acute asthma attacks unresponsive to inhalation therapy or control of bronchospasm dnring anesthesia, for bronchodilation, emergency treatment of cardiac arrhythmias, immediate temporary control of atropine-resistant hemodynamically significant bradycardia, and as adjnnct therapy in the treatment of shock. 

A study of the effect of bronchodilators on patients with chronic obstructive pulmonary disease who had atrial and/or ventricular arrhythmias following cessations of therapy for 16-24 hours compared isoproterenol (Iso) aerosol with 250 mg theophylline orally or intravenously (6 ) and stressed that theophylline compounds often worsened arrhythmias and should be used with caution. 

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