Key result
Anaphylactic shock was associated with a fall in heart rate of 5 to 50 beats per minute during the hypotensive period, indicating a strong and sometimes persistent vagal tone.
Case Report (n=5)
Anaphylactic shock can be associated with paradoxical bradycardia, indicating a strong vagal tone similar to hypotensive hypovolemic shock.
Paradoxical bradycardia may occur in anaphylactic shock; case-level data leave open mechanistic and prevalence questions for prospective study.
Five patients are reported with anaphylactic shock reactions due to i.v. administration of atracurium, methicillin, amidotrezoate (n = 2) and plasma. In these patients a fall in heart rate (HR) from 5-50 beats.min-1 was recorded during the hypotensive period. In three of the patients HR was 40 beats.min-1 or less, and in two of the patients a hypotensive bradycardiac episode spontaneously reappeared after normal HR and BP were established. Central venous pressure (CVP) fell in one patient from 0.8 to 0.6 kPa as HR and BP decreased while arterial oxygen tension remained normal. All patients were in a stable condition after treatment with volume expansion and sympathomimetic drugs. These observations indicate that anaphylactic shock is associated with a strong and sometimes persistent vagal tone to the heart in parallel with the early reaction to hypotensive hypovolaemic shock.
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Jacobsen et al. (1988) conducted a case report in Anaphylactic shock (n=5). Anaphylactic shock was evaluated on Heart rate during the hypotensive period. Anaphylactic shock was associated with a fall in heart rate of 5 to 50 beats per minute during the hypotensive period, indicating a strong and sometimes persistent vagal tone.
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