Cor Vasa 2022, 64(1):81-83 | DOI: 10.33678/cor.2021.073

(Junctional rhythm in verapamil intoxication)

Lubomír Ledvinka

Kardiologické oddělení, Nemocnice Jihlava, Jihlava

Junctional ectopic rhythm emanates from AV node, under the point of present conduction defect, with heart frequency usually between 40-50 beats per minute. Clinically significant SA node injury, which may be the trigger of junctional rhythm, may be inflicted e.g. by myocardial ischemia dominantly of the inferior heart wall or by the effect of some toxic agents. This case report depicts such junctional ectopic rhythm caused by the effect of a calcium channel blocker. Such poisoning is rare, but can have detrimental consequences. Calcium channel blockers function as antihypertensive, antianginal, and negatively inotropic drugs. They block slow calcium channels, which influence the generation and conduction of action potential in the heart and vessel myocytes. Overdose with these drugs may lead to peripheral vasodilation and due to its negatively inotropic effect even to cardiogenic shock and death. Early started treatment with efforts to maximize drug elimination and eventually use of external stimulation may increase the hope of survival. In our case firstly the acute coronary syndrome was excluded. Our suspicion of drug intoxication, even that it was denied by the patient, was ultimately established as the fatal cause. Our therapy was unfortunately unsuccessful possibly because of a long exposition to this toxic substance. The patient deteriorated progressively to cardiac arrest and died in spite of a prolonged cardiopulmonary resuscitation.

Keywords: Calcium channel blockers, Cardiac arrest, Cardiogenic shock, Drug intoxication, Junctional rhythm, Toxic substance elimination

Received: June 4, 2021; Revised: June 6, 2021; Accepted: June 8, 2021; Published: February 22, 2022  Show citation