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@article{Li:2017:10.1136/bcr-2016-216818,
author = {Li, Kam Wa ME and Taraborrelli, P and Hayat, S and Lim, PB},
doi = {10.1136/bcr-2016-216818},
journal = {BMJ Case Rep},
title = {Respiration driven excessive sinus tachycardia treated with clonidine.},
url = {http://dx.doi.org/10.1136/bcr-2016-216818},
volume = {2017},
year = {2017}
}

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TY  - JOUR
AB  - A 26-year-old man presented to our syncope service with debilitating daily palpitations, shortness of breath, presyncope and syncope following a severe viral respiratory illness 4years previously. Mobitz type II block had previously been identified, leading to a permanent pacemaker and no further episodes of frank syncope. Transthoracic echocardiography, electophysiological study and repeated urine metanepherines were normal. His palpitations and presyncope were reproducible on deep inspiration, coughing, isometric hand exercise and passive leg raises. We demonstrated rapid increases in heart rate with no change in morphology on his 12 lead ECG. His symptoms were resistant to fludrocortisone, flecainide, β blockers and ivabradine. Initiation of clonidine in combination with ivabradine led to rapid resolution of his symptoms. We suggest that an excessive respiratory sinus arrhythmia was responsible for his symptoms and achieved an excellent response with the centrally acting sympatholytic clonidine, where previous peripherally acting treatments had failed.
AU  - Li,Kam Wa ME
AU  - Taraborrelli,P
AU  - Hayat,S
AU  - Lim,PB
DO  - 10.1136/bcr-2016-216818
PY  - 2017///
TI  - Respiration driven excessive sinus tachycardia treated with clonidine.
T2  - BMJ Case Rep
UR  - http://dx.doi.org/10.1136/bcr-2016-216818
UR  - https://www.ncbi.nlm.nih.gov/pubmed/28455405
VL  - 2017
ER  -

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Dr P Boon Lim

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