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[Massive delayed-action verapamil poisoning]
A Hagège1, C Masquet, P Beaufils
1Service de cardiologie, hôpital Boucicaut, Paris.
Insights
A young woman experienced cardiogenic shock from a verapamil overdose, showing severe heart dysfunction and, for the first time, muscle damage. Isoproterenol was effective, but prolonged treatment was necessary.
Area of Science:
- Cardiology
- Clinical Pharmacology
- Toxicology
Background:
- Verapamil is a calcium channel blocker used for cardiovascular conditions.
- Overdose can lead to severe toxicity, including cardiovascular collapse.
- Sustained-release formulations may alter pharmacokinetic profiles and toxicity.
Observation:
- An 18-year-old woman presented with cardiogenic shock following ingestion of 16.8 g of sustained-release verapamil.
- Clinical examination revealed severe left ventricular diastolic dysfunction.
- New-onset myalgia and elevated MM isoenzyme of creatinine kinase indicated muscular involvement.
Findings:
- The patient developed profound cardiogenic shock and severe diastolic dysfunction.
- This case is the first to report muscular involvement (myalgia, elevated CK-MM) in verapamil toxicity.
- Isoproterenol demonstrated efficacy in managing the cardiovascular compromise.
Implications:
- This case highlights the potential for severe cardiotoxicity and multisystem involvement with massive verapamil overdose.
- The findings underscore the importance of recognizing and managing muscle-related complications.
- Prolonged treatment and intensive monitoring are crucial for favorable outcomes in severe verapamil poisoning.
Abstract:
An 18-year old woman developed cardiogenic shock after ingestion of 16.8 g of a sustained release form of verapamil. Severe left ventricular diastolic dysfunction was demonstrated. For the first time muscular involvement was observed with myalgia and elevation of the MM isoenzyme of creatinine kinase. The efficacy isoproterenol and the need for prolonged treatment are emphasised.