Loperamide-induced ventricular tachycardia storm.

Area of Science:

• Cardiology
• Clinical Toxicology
• Pharmacology

Background:

• Loperamide, an over-the-counter medication for diarrhea, is a μ-opioid receptor agonist.
• It is increasingly recognized for its potential for misuse and abuse.
• High doses can lead to severe cardiac toxicity, including fatal arrhythmias.

Purpose of the Study:

• To report a case of loperamide misuse leading to life-threatening cardiac events.
• To highlight the diagnostic challenges and clinical outcomes associated with loperamide abuse.
• To emphasize the cardiac risks of high-dose loperamide use.

Main Methods:

• Case report of a young woman with a history of depression.
• Presentation with syncope secondary to ventricular tachycardia (VT).
• Management in emergency and tertiary cardiac centers, including electrical cardioversion and intubation.

Main Results:

• The patient experienced recurrent monomorphic pulseless VT requiring multiple cardioversions.
• Loperamide misuse was discovered several days after admission, complicating initial diagnosis.
• The final diagnosis was loperamide-induced secondary long-QT syndrome.

Conclusions:

• Loperamide misuse can precipitate severe cardiac arrhythmias and long-QT syndrome.
• Diagnostic delays can occur when substance misuse is not immediately apparent.
• Early recognition and management are crucial for patient recovery from loperamide cardiotoxicity.