Diuretic-induced ventricular ectopic activity

O. Bryan Holland, J. V. Nixon, LaVon Kuhnert

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Abstract

The need to avoid hypokalemia during diuretic therapy in nondigitalized patients has been questioned. Twenty-one patients with (1) mild essential hypertension, (2) plasma potassium of < 3.5 meq/liter during previous diuretic treatment, and (3) normal findings {< 6 unifocal ventricular premature beats/hour} on 24-hour ambulatory electrocardiographic monitoring and exercise testing were treated with hydrochlorothiazide (50 mg twice a day) for four weeks and then ambulatory electrocardiographic monitoring and exercise testing were repeated. Ambulatory electrocardiographic monitoring revealed that ventricular ectopic activity developed in seven patients and complex ventricular ectopic activity (multifocal ventricular premature beats, ventricular couplets and/or ventricular tachycardia) in four. Only two of these seven had ventricular ectopic activity during exercise testing while they were hypokalemic. Potassium repletion in these seven patients with spironolactone abolished complex ventricular ectopic activity and reduced unifocal ventricular premature beats significantly (p < 0.01) from an average of 71.2 ventricular premature beats/hour/patient during hydrochlorothiazide treatment to 5.4 ventricular premature beats/hour/patient after potassium repletion. Although complex ventricular ectopic activity was more likely to occur with plasma potassium < 3.0 meq/ liter, restoration of normokalemia was required in several patients to abolish residual ventricular ectopic activity. Persistent ventricular ectopic activity in one patient suggested that myocardial injury sustained during hypokalemia may initiate chronic ventricular ectopic activity. Even in nondigitalized patients, the hazard of diuretic-induced ventricular ectopic activity warrants correction of hypokalemia.

Original languageEnglish (US)
Pages (from-to)762-768
Number of pages7
JournalThe American Journal of Medicine
Volume70
Issue number4
DOIs
StatePublished - 1981

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Diuretics
Ventricular Premature Complexes
Ambulatory Electrocardiography
Hypokalemia
Potassium
Hydrochlorothiazide
Exercise
Spironolactone
Ventricular Tachycardia
Therapeutics
Wounds and Injuries

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Diuretic-induced ventricular ectopic activity. / Holland, O. Bryan; Nixon, J. V.; Kuhnert, LaVon.

In: The American Journal of Medicine, Vol. 70, No. 4, 1981, p. 762-768.

Research output: Contribution to journalArticle

Holland, O. Bryan ; Nixon, J. V. ; Kuhnert, LaVon. / Diuretic-induced ventricular ectopic activity. In: The American Journal of Medicine. 1981 ; Vol. 70, No. 4. pp. 762-768.
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