Abstract：
Atropine, a competitive antagonist of acetylcholine muscarinic receptors, is commonly used to treat severe bradycardia by blocking parasympathetic activity. We present a rare case of hypertensive emergency following atropine administration, with only one previous report in the literature. A 78-year-old woman with essential hypertension and hypercholesterolemia was admitted to the cardiac intensive care unit for non-ST segment elevation myocardial infarction. During coronary angiography, an occlusion of the right coronary artery was identified. While removing the diagnostic catheter through the right radial artery, the patient experienced intense pain and discomfort, accompanied by a vasovagal reflex characterized by bradycardia and hypotension. Intravenous atropine (0.5mg) was administered, leading to a rapid rise in heart rate with frequent ventricular ectopy. Subsequently, a progressive and exaggerated elevation in arterial blood pressure occurred, peaking at 294/121mmHg approximately 10min after atropine administration. The patient developed hypertensive acute pulmonary edema, successfully treated with intravenous nitroglycerine (10mg) and furosemide (60mg). Blood pressure normalized after approximately 14min. The exact mechanism of atropine-induced hypertensive emergency remains unknown. While hypertensive emergencies with atropine are exceedingly rare, healthcare professionals should be aware of this potential effect and be prepared for prompt intervention.
摘要：
阿托品,乙酰胆碱毒蕈碱受体的竞争性拮抗剂，通常用于通过阻断副交感神经活动来治疗严重的心动过缓。我们介绍了一例罕见的阿托品给药后的高血压急症，文献中只有一份先前的报告。一名患有原发性高血压和高胆固醇血症的78岁女性因非ST段抬高心肌梗死而被送往心脏重症监护病房。在冠状动脉造影期间，发现右冠状动脉闭塞.通过右桡动脉拔除诊断导管时,患者经历了剧烈的疼痛和不适，伴有以心动过缓和低血压为特征的血管迷走反射。静脉注射阿托品（0.5mg），导致心率快速升高并伴有频繁的心室异位.随后，出现了动脉血压的进行性和夸大的升高，阿托品给药后约10分钟达到294/121mmHg的峰值。患者出现高血压性急性肺水肿,成功用静脉注射硝酸甘油（10mg）和呋塞米（60mg）治疗。约14min后血压恢复正常。阿托品引起的高血压急症的确切机制尚不清楚。虽然患有阿托品的高血压急症极为罕见，医疗保健专业人员应该意识到这种潜在的影响，并为及时干预做好准备。
