Malignant Hyperthermia

Dunn, Debra

doi:10.1016/s0001-2092(06)62996-7

Cited by 10 publications

(8 citation statements)

References 4 publications

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“…This adverse effect of fever is commonly associated with a variety of factors including tricyclic antidepressant poisoning,4 overdose of quinine,8 amphetamines or digitalis,2 long QT intervals,11, 12 long QT and/or acute rheumatic fever,5, 6 the Brugada syndrome,10 malignant hyperthermia induced by anesthesia 3. Fever-induced VF has been reported in humans without detectable structural abnormalities or other factors known to precipitate sudden cardiac death 9.…”

Section: Discussionmentioning

confidence: 99%

Fever Accentuates Transmural Dispersion of Repolarization and Facilitates Development of Early Afterdepolarizations and Torsade de Pointes Under Long-QT Conditions

Burashnikov

Shimizu

Antzelevitch

2008

Circ: Arrhythmia and Electrophysiology

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Background-The arrhythmogenic effects of hyperthermia have been highlighted in the Brugada syndrome but remain largely unexplored in other arrhythmic syndromes. The present study examines the effect of hyperthermia on transmural dispersion of action potential duration (TD-APD), early afterdepolarization (EAD) activity, and torsade de pointes (TdP) under long-QT conditions. Methods and Results-Standard and floating glass microelectrodes were used to record action potentials from epicardial, M cell, and endocardial regions of the arterially perfused left ventricle wedge, from tissue slices isolated from these regions, and from isolated Purkinje fibers. A transmural ECG was simultaneously recorded across the wedge. Under baseline conditions and in the presence of I Ks block (chromanol 293B), hyperthermia (39°C to 40°C) abbreviated APD in tissue slices from all 3 regions. In the presence of I Kr block (E-4031), hyperthermia prolonged APD and induced or augmented EADs in M cell and Purkinje preparations at pacing cycle lengths Ն800 ms but abbreviated APD in epicardium and endocardium, resulting in a marked accentuation of TD-APD. Ryanodine prevented the hyperthermiainduced EAD. In perfused wedge preparations, hyperthermia abbreviated APD throughout both in the absence or presence of I Kr or I Ks block and did not induce EADs or TdP. Combined I Kr and I Ks block increased TD-APD and induced EADs (4/12) and spontaneous TdP (3/12) at 36°C to 37°C; hyperthermia (39°C to 40°C) further accentuated TD-APD and facilitated the development of EAD activity (9/12) and TdP (6/12). Conclusions-Our findings suggest that hyperthermia can be associated with an increased arrhythmic risk when the repolarization reserve of the myocardium is compromised.

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Section: Discussionmentioning

confidence: 99%

Fever Accentuates Transmural Dispersion of Repolarization and Facilitates Development of Early Afterdepolarizations and Torsade de Pointes Under Long-QT Conditions

Burashnikov

Shimizu

Antzelevitch

2008

Circ: Arrhythmia and Electrophysiology

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“…If the triggering agent is continued, other clinical signs of MH such as tachycardia, temperature elevation, and acidosis will manifest. An elevated end-tidal carbon dioxide is felt to be the most valuable early sign of malignant hyperthermia based on multiple studies (Byers & Green, 1992;Dunn, 1997;Kaplan, 1997;Rosenberg, 1996).…”

Section: Other Findingsmentioning

confidence: 99%

“…Continuous skeletal muscle rigidity, hypermetabolism, hypercapnea, tachypnea, and tachycardia that can result in cardiac arrest characterize the MH syndrome if left untreated (Dunn, 1997). According to MHAUS consultants, Karan and Greenberg (1997), recent trends from the MH Hotline indicate that more episodes are having a wider Malignant Hyperthermia 3 variation in clinical signs and presenting symptoms.…”

mentioning

confidence: 99%

“…Hyperthermia is felt to be a late sign as volatile anesthetics can alter the thermoregulatory responses. Although it is considered a late sign, hyperthermia is still considered one of the classical hallmark signs that help confirm the diagnosis of MH with the presence of other known symptoms (Dunn, 1997). Karan and Greenberg (1997) state that all MH cases do not progress at the same rate or with the same consistent set of symptoms.…”

mentioning

confidence: 99%

“…Elevated end-tidal carbon dioxide (CO2) monitoring is now felt to be the most valuable early sign of malignant hyperthermia (Dunn, 1997;Kaplan, 1997;McCarthy, 1997;Rosenberg, 1996). Kaplan (1997) estimates the incidence of a classic fulminant episode to be approximately one in 200,000 patients not having administration of succinylcholine and one in 50,000 patients with the administration of succinycholine.…”

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confidence: 99%

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Differences in the Onset and Severity of Symptoms of Malignant Hyperthermia with Different Inhalational Anesthetics

Solberg¹

1999

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Malignant hyperthermia (MH) is an uncommon inherited disorder of skeletal muscle in which commonly used anesthetics can trigger sustained skeletal muscle hypermetabolism in patients who may have had no symptoms previously. The onset and severity of clinical symptoms of MH are variable. Non-clinical studies and case reports have identified differences in the onset and severity of symptoms with the commonly used volatile anesthetics. The purpose of this study was to identify if there is a significant difference in the onset and severity of signs and symptoms of malignant hyperthermia in those MH-susceptible patients who received the different volatile anesthetics. A comparative descriptive research design was used. A retrospective review of the database at the (USUHS) MH muscle biopsy diagnostic center was done. The data collected was used to determine if there was a difference in the onset and severity of signs and symptoms of MH episodes with halothane compared to MH episodes of four other volatile anesthetics. For each of these groups, the following variables were assessed: highest temperature, highest end-tidal carbon dioxide, time from beginning of anesthetic until onset of first MH symptom, time of onset of anesthesia until initial treatment for MH, and the incidence of masseter spasm. Based on results of this study, there was no significant difference among the groups. As much of the pediatric data was excluded, the results may have been skewed. Further studies examining these differences between volatile anesthetics would be extremely valuable in understanding the pathophysiology of malignant hyperthermia.

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Low-Dose Dantrolene Is Effective in Treating Hyperthermia and Hypercapnia, and Seems Not to Affect Recovery of the Allograft After Liver Transplantation: Case Report

Shih

Chen

Pao

et al. 2010

Transplantation Proceedings

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Malignant Hyperthermia

Cited by 10 publications

References 4 publications

Fever Accentuates Transmural Dispersion of Repolarization and Facilitates Development of Early Afterdepolarizations and Torsade de Pointes Under Long-QT Conditions

Fever Accentuates Transmural Dispersion of Repolarization and Facilitates Development of Early Afterdepolarizations and Torsade de Pointes Under Long-QT Conditions

Differences in the Onset and Severity of Symptoms of Malignant Hyperthermia with Different Inhalational Anesthetics

Low-Dose Dantrolene Is Effective in Treating Hyperthermia and Hypercapnia, and Seems Not to Affect Recovery of the Allograft After Liver Transplantation: Case Report

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