Modified release verapamil induced cardiogenic shock

Area of Science:

• Cardiology
• Pharmacology

Background:

• Cardiogenic shock secondary to acute myocardial infarction is a frequent emergency department presentation.
• While refractory cardiogenic shock has been documented with combined verapamil and metoprolol, isolated cases from single oral verapamil doses are rare.

Observation:

• A patient presented with severe cardiogenic shock after ingesting a single therapeutic oral dose of modified-release verapamil.
• The patient's condition rapidly deteriorated, indicating a significant negative inotropic effect.

Findings:

• This case represents the first reported instance of life-threatening cardiogenic shock induced by a single therapeutic oral dose of modified-release verapamil alone.
• The patient experienced a remarkable and swift recovery following the administration of intravenous calcium chloride.

Implications:

• This case underscores the potent negative inotropic properties of verapamil, even at a single therapeutic oral dose.
• It emphasizes the critical importance of recognizing and promptly treating verapamil-induced myocardial depression with calcium chloride.