Hypertensive emergency secondary to atropine

Area of Science:

• Cardiology
• Pharmacology

Background:

• Atropine is a standard treatment for symptomatic bradycardia, antagonizing muscarinic receptors to reduce parasympathetic tone.
• A vasovagal response with bradycardia and hypotension occurred during cardiac catheterization.

Observation:

• A 78-year-old woman developed severe hypertension (294/121mmHg) and acute pulmonary edema shortly after receiving intravenous atropine (0.5mg) for bradycardia.
• The patient experienced ventricular ectopy preceding the hypertensive crisis.

Findings:

• This case represents a rare instance of atropine-induced hypertensive emergency, with only one prior report.
• The exact mechanism underlying this severe hypertensive response to atropine remains unclear.

Implications:

• Healthcare providers should be aware of the potential for atropine to precipitate hypertensive emergencies, even if rare.
• Prompt recognition and management, including antihypertensive and diuretic therapy, are crucial for patient outcomes.