[Electrocardiographic changes in acute organophosphate poisoning]

Area of Science:

• Toxicology
• Cardiology
• Emergency Medicine

Background:

• Organophosphate (OP) poisoning is a significant global health concern, primarily known for its neurological effects.
• Cardiac complications, though less understood, can be severe and fatal in OP poisoning.
• Myocardial infarction is a rarely reported but serious cardiac event in acute pesticide poisoning.

Observation:

• A 57-year-old woman ingested organophosphates, presenting with coma and non-cardiogenic pulmonary edema.
• She experienced asystole, requiring resuscitation, and subsequent cardiac abnormalities including prolonged QTc, ST-T changes, right bundle branch block, and ventricular tachycardia.
• The patient ultimately developed acute anteroseptal myocardial infarction and died despite normalized cholinesterase levels.

Findings:

• Organophosphate exposure can lead to a spectrum of cardiac toxicity, including arrhythmias and conduction defects.
• Acute myocardial infarction is a potential, albeit rare, complication of severe organophosphate poisoning.
• Cardiac events may occur even after initial toxicological markers, like cholinesterase levels, normalize.

Implications:

• Intensive care unit (ICU) admission is vital for patients with organophosphate poisoning.
• Continuous electrocardiographic (ECG) and cardiac enzyme monitoring are essential for early diagnosis and management of cardiac complications.
• Understanding the pathogenesis of OP-induced cardiotoxicity is critical for improving patient outcomes.