Sympathetic overactivity and arrhythmias in tetanus: electrocardiographic analysis

Abstract

As a result of the advances in the control of pulmonary insufficiency in tetanus, the cardiovascular system has increasingly been shown to be a determining factor in morbidity and mortality but detailed knowledge of the cardiovascular complications in tetanus is scanty. The 24h-Holter was carried out in order to detect arrhythmias and sympathetic overactivity in 38 tetanus patients admitted to an ICU. The SDNN Index (standard deviation from the normal R-to-R intervals), was useful in detecting adrenergic tonus, and ranged from 64.1 +/- 27 in the more severe forms of tetanus to 125 +/- 69 in the milder ones. Sympathetic overactivity occurred in 86.2% of the more severe forms of the disease, but was also detected in 33% of the milder forms. Half the patients had their sympathetic overactivity detected only by the Holter. The most frequent arrhythmias were isolated supraventricular (55.2%) and ventricular (39.4%) extrasystoles. There was no association of the arrhythmias with the clinical form of tetanus or with the presence of sympathetic overactivity. The present study demonstrated that major cardiovascular dysfunction, particularly sympathetic overactivity, occurs in all forms of tetanus, even in the milder ones. This has not been effectively detected with traditional monitoring in ICU and may not be properly treated.

Toxin-associated infectious diseases: tetanus, botulism and diphtheria

“…Spasms of the laryngeal muscles can be life-threatening by causing airway obstruction. General tetanus is associated with autonomic overactivity, which is the leading cause of death [31]. Profuse sweating, tachyarrhythmia, hyperpyrexia, hypertension alternating with bradycardia and hypotension are frequently seen.…”

Diretrizes para o manejo do tétano acidental em pacientes adultos

“…Such patients therefore require a more aggressive approach. (5,6,24,25,(27)(28)(29)(30)(31)(32)(33) Mortality is also related to the severity classification. Although the mortality rate of mild tetanus is low, patients with severe and very severe disease are more likely to die and should be intensively monitored and treated.…”

The management of tetanus in adults in an intensive care unit in Southern Vietnam

“…Tetanus is a vaccine-preventable disease that remains a common cause of acute critical illness in low-income and middle-income countries (LMICs) 1 . Signs and symptoms are due to the effects of tetanus toxin in the central nervous system and management is based on three key strategies: blocking further tetanus toxin release 2 , neutralising unbound toxin 3 , and alleviating effects of already-bound toxin; namely muscle spasms and autonomic nervous system dysfunction 1 , 4 , 5 . With access to critical care interventions such as mechanical ventilation and advanced physiological monitoring, muscle spasms and autonomic nervous system dysfunction (ANSD) can be more easily managed 6 – 8 .…”