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Related Experiment Videos

Complete atrioventricular block after sublingual isosorbide dinitrate.

D Antonelli, J Barzilay

    International Journal of Cardiology
    |January 1, 1986
    PubMed
    Summary
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    A patient experienced cardiac arrest after receiving isosorbide dinitrate and lidocaine. This case highlights a potential dangerous drug interaction between these medications, emphasizing the need for careful patient monitoring.

    Area of Science:

    • Cardiology
    • Clinical Pharmacology

    Background:

    • A 71-year-old female patient presented with chest pain.
    • She was undergoing treatment for ventricular premature beats with intravenous lidocaine.

    Observation:

    • The patient received sublingual isosorbide dinitrate (5 mg).
    • Within minutes, she developed pallor, diaphoresis, and lost consciousness.
    • Electrocardiogram monitoring revealed sinus bradycardia progressing to ventricular asystole.

    Findings:

    • Ventricular asystole occurred shortly after isosorbide dinitrate administration.
    • Sinus rhythm was successfully restored with a precordial thump and atropine.
    • A potential interaction between intravenous lidocaine and isosorbide dinitrate is suspected as the cause of asystole.

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    Implications:

    • This case underscores the critical importance of considering potential drug-drug interactions in patients with cardiovascular conditions.
    • Clinicians should exercise caution when co-administering nitrates and antiarrhythmic agents like lidocaine.
    • Enhanced vigilance and monitoring are crucial in patients receiving multiple cardiovascular medications to prevent adverse events.