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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which...
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Class I antiarrhythmic drugs are used to treat various types of arrhythmias or irregular heart rhythms. These drugs block the sodium (Na+) channels in the cardiac cells, thereby affecting the movement of electrical impulses across the heart. Class I antiarrhythmic drugs are divided into three subgroups: Class IA, Class IB, and Class IC, each with distinct mechanisms of action and effects on the heart.
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Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
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Class III antiarrhythmic drugs are a group of medications that can prolong action potentials in the heart. They achieve this by blocking potassium channels or enhancing inward currents from sodium channels. However, these drugs have a unique property of "reverse use-dependence," which is most pronounced at slower heart rates and can lead to torsades de pointes—a specific type of arrhythmia. However, it is essential to note that excessive QT interval prolongation—a measure of...
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Ganglionic blockers inhibit autonomic activity by blocking nicotinic receptors in the autonomic ganglia, suppressing impulse transmission. These blockers lack selectivity between sympathetic and parasympathetic ganglia and are ineffective as neuromuscular junction antagonists. They can be categorized into two groups:
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Updated: Jun 17, 2025

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Reversible Second-Degree Heart Block Attributed to Ondansetron: A Rare Side Effect.

Abey Sebastian1, Emmanuel Bhaskar2, Swathy Moorthy1

  • 1Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.

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Summary

Ondansetron, an antiemetic, can cause heart block in pregnant patients. This case highlights the importance of monitoring cardiac rhythm after ondansetron administration during labor.

Keywords:
adverse effectbradycardiamobitz heart blockondansteronprimigravida

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Area of Science:

  • Cardiology
  • Obstetrics
  • Pharmacology

Background:

  • A primigravida at 36 weeks gestation with gestational diabetes and hypothyroidism presented for delivery.
  • Cesarean delivery was performed due to breech presentation and labor progression issues.

Observation:

  • During anesthesia induction, asymptomatic sinus bradycardia (heart rate 40 bpm) was noted.
  • An electrocardiogram (ECG) revealed Mobitz type I second-degree heart block after intravenous pantoprazole and ondansetron administration.
  • The heart block progressed to Mobitz type II and persisted for 16 hours, with the patient remaining asymptomatic.

Findings:

  • Recurrence of second-degree heart block was observed after a second dose of ondansetron for vomiting.
  • The cardiac rhythm disturbance was directly attributed to ondansetron.
  • Complete rhythm normalization occurred within 36 hours.

Implications:

  • Ondansetron may pose a risk for inducing or exacerbating heart block in susceptible obstetric patients.
  • Close cardiac monitoring is crucial for pregnant patients receiving ondansetron, especially those with pre-existing risk factors.
  • Further research is warranted to elucidate the mechanism and incidence of ondansetron-induced cardiac conduction abnormalities in pregnancy.