Treating bradyarrhythmias without using pacemakers.

and other wonders of the methylxanthines PREMIUM CONTENT

Everything old is new again.

In 1833, the physician James Hope coined the term cardiac asthma to describe the sensation of breath hunger resulting from inadequate oxygenation of blood - usually due to left heart failure. Theophylline is a longstanding therapy available for the broad general indication, “asthma”. Knowing this old school nugget sure did come in handy when my colleague, Blaze Sekovski, and I were tasked with covering the General Medicine Ward at Erie County Medical Center in the early 1990’s.

Being a last resort public hospital, we often got admissions from nursing homes. These were dementia patients with no family and no known DNR status, but presented in a critical state, vital signs crashing. Because Blaze was a very capable cardiologist, the ER docs targeted all the heart cases to our ward when the intensive care beds were scarce. But we couldn’t insert and monitor a pacemaker on that service - it lacked the necessary personnel and equipment. Still, we felt they deserved a chance to ‘tune up’ and return to the home.

So when bradycardia manifested, we tried low dose theophylline therapy to “improve their breathing” - by ameliorating their cardiac state. It stimulated the heart rate, relieved the nodal block, increased ejection fraction, and diuresed pulmonary edema. And often our efforts were successful! When we accumulated enough case reports, we decided to write it up as a series. The paper was published in Pharmacotherapy in 1992.

Turns out, that it is the most popular publication I have published [well… so far.] It is still viewed at least 5 times per week, by readers from across the world. Folks find it … useful.

theophylline