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Diphenhydramine overdose and Brugada sign
Beatriz López-Barbeito1, Meritxell Lluis, Victoria Delgado
1Intensive Care Unit, Emergency Department and Arrhythmia Section, Institut Clinic de Malalties Cardiovasculars, IDIBAPS, Hospital Clinic, Spain.
Pacing and Clinical Electrophysiology : PACE
|July 13, 2005
Summary
Diphenhydramine overdose can mimic Brugada syndrome, causing dangerous ECG changes. Prompt identification and management of the overdose are crucial for patient recovery.
Area of Science:
- Cardiology
- Medical Toxicology
Background:
- Brugada syndrome is a genetic disorder characterized by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death.
- Drug-induced ECG changes can sometimes mimic primary cardiac conditions, complicating diagnosis and management.
Observation:
- A 39-year-old male presented with unconsciousness and hypotension after a diphenhydramine overdose.
- Initial ECG revealed coved-type ST-segment elevation in leads V2-V3, consistent with Brugada syndrome.
- These ECG abnormalities persisted despite correction of hyperkalemia and isoproterenol infusion.
Findings:
- The patient's ECG abnormalities resolved as his diphenhydramine toxicity improved.
- A subsequent flecainide challenge test was negative, ruling out underlying Brugada syndrome.
- The findings indicate that diphenhydramine overdose can transiently induce Brugada-like ECG patterns.
Implications:
- This case highlights the importance of considering toxicological causes for Brugada-like ECG patterns.
- Diphenhydramine should be recognized as a potential agent that can induce significant cardiac repolarization abnormalities.
- Accurate diagnosis is essential to avoid unnecessary long-term management for a condition not present in the patient.