NEOSTIGMINE-INDUCED BRADYCARDIA FOLLOWING RECENT VS REMOTE CARDIAC TRANSPLANTATION IN THE SAME PATIENT

Purpose: This report describes the effects of neostigmine on heart rat e in the same patient following recent and remote cardiac transplantat ion. Clinical features: Eighty-six months following the first transpla nt, neostigmine 5.0 mu g . kg(-1) iv produced a 10% reduction in heart rate which was reversed by atropine 1.2 mg. For 24 months prior to th is initial study, the patient experienced angina, suggesting cardiac a fferent reinnervation. Three months after the second heart transplant, a second study showed that a six-fold increase in the dose of neostig mine, 30.0 mu g . kg(-1), only produced a 3.5% reduction in heart rate which was reversed by atropine 1.2 mg. Conclusions: These observation s indicate that neostigmine produces bradycardia following cardiac tra nsplantation, and suggest that a greater response may be observed in r emotely than in recently transplanted patients.