The importance of the heart in cluster headache treatment  

Oleh:

May, Arne

Jenis: Article from Bulletin/Magazine - ilmiah internasional
Dalam koleksi: Medical Progress vol. 35 no. 05 (May 2008), page 213.

Ketersediaan

Perpustakaan FK Nomor Panggil: M36.K.2008.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

Lihat Detail Induk

Isi artikel

BACKGROUND: To assess electrocardiogram (ECG) monitoring in outpatients with cluster headache (CH) who are receiving high-dose verapamil. DESIGN: The current study included patients with episodic or chronic CH who were seen at headache clinic in the UK between September 2001 and September 2005. The CH diagnoses were consistent with the second iteration of the International Classification of Headache Disorders. A total of 217 patients (175 men) received verapamil therapy. Treatment was started at 240 mg/day, and the dose increased by 80 mg every 2 weeks until the CH was supressed, side effects intervened, or until a maximum dose of 960 mg/day was reached. The study monitored whether ECG checks were performed and which cardiac side effects ocurred under treatment with verapamil. The mean dose achieved was 512 mg/day (range 20 to 1,200 mg/day). RESULTS: In total, 89 (41%) patients (71 male) on verapamil therapy did not undergo ECG monitoring, mainly because of reluctante by either the patients or their local services to undertake such frequent assessment (provided reason in 42 [47%] cases). The remaining 128 (59%) patients had ECGs performed while on verapamil, but 20 of these ECGs were not available in the hospital notes because the recordings had been performed elsewhere. The incidence of abnormalities in atrioventricular conduction among the 108 patients with available ECGs was 19% (n=21). First-degree heart block (PR interval >0.2 s) was noted in 13 (12%) patients, with one patient requiring a permanent pacemaker. Additionally, nine (8%) patients had other arrhytmias (four junctional rhythm, one second-degree heart block, four right bundle branch block). In eight (7%) patients, the PR interval lengthened with increasing doses of verapamil, but it remained below the 0.2 sthreshold for first-degree and second-degree heart block, respectively, after >1 year of treatment at a stable dose. Bradycardia(heart rate <60 beats/min) was observed in 39 (36%) of the patients with available ECGs, but verapamil therapy was stopped in only four of these cases. There was no indication that the ECG abnormalities on verapamil were associated with age. CONCLUSION: One in five patients had cardiac arrhytmias while receiving verapamil, and in some cases clinically significant ECG abnormalities developed over time even with treatment at a stable dose. Despite the high risk of ECG abnormalities in this population, a substantial number of patients with CH had no ECGs performed while receiving high-dose verapamil, or the ECG was not available.

Opini Anda

Klik untuk menuliskan opini Anda tentang koleksi ini!

Kembali