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Vasopressin Induction of Ventricular Ectopy

J. D. Fitz, MC, USA
Arch Intern Med. 1982;142(3):644. doi:10.1001/archinte.1982.00340160224043.
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To the Editor.  —Parenterally administered vasopressin injection is well known to have generalized vasoconstrictive properties.1 Diminished coronary artery flow at the time of elevated peripheral resistance may be the cause of the well-verified association between vasopressin and myocardial ischemia.2

Report of a Case.  —A 67-year-old man with macronodular cirrhosis but without known heart disease was initially seen with hematemesis, and, on endoscopy, esophageal varices were seen. Recurrent bleeding was treated successfully with a Sengstaken-Blakemore apparatus. A second recurrence of bleeding was treated by a constant infusion of intravenous vasopressin. After 60 minutes, a slow idioventricular rhythm was noted that rapidly degenerated into terminal asystole.

Comment.  —Although myocardial ischemia was noted in 1925 in dogs given pituitary extract,3 similar effects in patients were not verified until 1949, despite the common diagnostic use of vasopressin to clear intestinal gas during cholecystography.4 Subsequently, reversible ischemic ECG changes were


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