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Complete atrioventricular block after sublingual isosorbide dinitrate
A 71-year-old woman, admitted for chest pain, received a 5 mg dose of isosorbide dinitrate sublingually. Within 2 min she became pale and diaphoretic and soon after lost consciousness. A monitor electrocardiographic lead showed sinus bradycardia followed by ventricular asystole. Sinus rhythm was restored by a precordial thump and intravenous administration of atropine. Our patient was receiving lidocaine intravenously because of ventricular premature beats. Its interaction with isosorbide is suspected of having caused the asystole.
A 71-year-old woman, admitted for chest pain, received a 5 mg dose of isosorbide dinitrate sublingually. Within 2 min she became pale and diaphoretic and soon after lost consciousness. A monitor electrocardiographic lead showed sinus bradycardia followed by ventricular asystole. Sinus rhythm was restored by a precordial thump and intravenous administration of atropine. Our patient was receiving lidocaine intravenously because of ventricular premature beats. Its interaction with isosorbide is suspected of having caused the asystole.