[Cardiac complications associated with organophosphate poisoning]

The clinical picture of organophosphate poisoning is dominated by respiratory and neurological signs. Cardiac complications are rare, serious and little known by clinicians.

F.B, 17 years, was addressed intubated, at the emergencies after an organosphorus poisoning. At admission, the patient was comatose with a muscarinic syndrome. Her hemodynamic was stable. Chest radiography and ECG of admission were normal. A gastric washing and a treatment by atropine were quickly started. The toxicological analysis of gastric liquid showed presence of malathion. After 20hours, the patient presented a cardiogenic shock. Chest radiography showed signs of acute pulmonary edema and ECG: a circumferential endocardic ischaemia. In spite of vasopressors and positive inotropic treatment, the patient quickly died. The autopsies revealed multiple necrosis of the heart.

The cardiac symptoms are caused by many mechanisms often associated. The cardiac attack appears primarily by many electrocardiographic modifications: arrhythmias, disturb of repolarisation, conduction's disorder... On the hemodynamic plan, a circulatory insufficiency is possible. The ventricular arrhythmias, which are not treated by lidocaine or electric cardioversion are treated effectively by injection of isoproterenol and/or ventricular stimulation, and recently by the use of magnesium salts.

If the clinical picture of the IOP is dominated by neurological and respiratory signs, it is always necessary to remember the possibility of cardiac complications (early or late) whose pronostic is very often bad.