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Potential for Infra-Nodal Heart Block and Cardiogenic Shock With Propofol Administration.

Nicholas Olson¹, Michael J Lim¹, Scott W Ferreira¹

¹Saint Louis University, Department of Cardiology, 3635 Vista Avenue, Saint Louis, MO, 63110-0250, 13th floor Desloge Tower, 63110-0250, USA.

Cardiology Research

|March 29, 2017

Summary

Propofol can cause heart block, but this case shows a rare, sustained infra-nodal heart block. Prompt recognition and intervention, including pacing, are crucial for patient recovery.

Keywords:

Anesthesia Cardiogenic shock Cardiomyopathy Heart block Heart failure Hypotension Impella Left ventricular assist device Propofol Propofol infusion syndrome

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Area of Science:

Cardiology
Anesthesiology
Pharmacology

Background:

Propofol is a common anesthetic agent.
Transient bradycardia and heart block are known side effects of Propofol.
These effects are typically transient and related to the atrioventricular (AV) node.

Observation:

A previously healthy 64-year-old man developed infra-nodal complete heart block and cardiogenic shock.
This severe cardiac event occurred after receiving 180 mg of intravenous propofol.
The heart block was sustained and not transient.

Findings:

This case represents the first documented instance of sustained, complete infra-nodal heart block following propofol administration.
The mechanism appears to be distinct from the commonly observed transient, AV nodal effects.
The patient experienced cardiogenic shock secondary to the heart block.

Implications:

Early identification of sustained infra-nodal heart block is critical in patients receiving propofol.
Restoring atrio-ventricular (A-V) synchrony via dual-chamber pacing is essential.
Aggressive circulatory support is necessary to manage cardiogenic shock and facilitate recovery.