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Brugada-Type Pattern on Electrocardiogram Associated with High-Dose Loperamide Abuse.

Christie Sun1, Jessica A Brice2, Richard F Clark1

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Loperamide abuse can cause dangerous heart rhythm changes, including Brugada-like patterns on ECGs. Emergency physicians should monitor for these cardiac risks in patients misusing loperamide.

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Area of Science:

  • Cardiology
  • Clinical Toxicology
  • Emergency Medicine

Background:

  • Loperamide, an over-the-counter medication for diarrhea, is increasingly abused for central nervous system effects.
  • High-dose loperamide use is associated with significant risks, including cardiotoxicity.
  • Abuse of loperamide can lead to various cardiac complications beyond its intended use.

Observation:

  • A case of a 49-year-old male with chronic loperamide abuse presented with new Brugada-like changes on electrocardiogram (ECG).
  • The patient had no prior history of Brugada syndrome or similar ECG findings.
  • These Brugada-like ECG changes resolved after the patient discontinued loperamide use during hospitalization.

Findings:

  • Loperamide abuse can induce Brugada-like ECG abnormalities.
  • These ECG changes may be reversible upon cessation of loperamide.
  • The absence of other symptoms does not rule out loperamide-induced cardiotoxicity.

Implications:

  • Emergency physicians must consider loperamide abuse in patients presenting with unexplained cardiac abnormalities, particularly Brugada-like ECG changes.
  • Prompt recognition and management of loperamide cardiotoxicity are crucial.
  • Awareness of this association can prevent misdiagnosis and ensure appropriate patient care.