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[Sinus arrest after intravenous administration of lidocaine]
Insights
Lidocaine infusion can cause sinus standstill and bradycardia in patients with coronary artery disease. Atropine effectively restored sinus rhythm and improved blood pressure in a patient experiencing this adverse event.
Area of Science:
- Cardiology
- Clinical Pharmacology
Background:
- Coronary artery disease (CAD) and prior myocardial infarction (MI) are significant risk factors for cardiac arrhythmias.
- Antiarrhythmic drug therapy, such as lidocaine, is commonly used in managing cardiac conditions but can have adverse effects.
Observation:
- A 60-year-old patient with a history of CAD and MI developed sinus standstill with severe bradycardia (41/min) during a lidocaine infusion.
- Concomitant severe hypotension (70/50 mm Hg) was noted during the episode.
- The patient was receiving lidocaine at a rate of 2 mg/min for antiarrhythmic treatment.
Findings:
- Withdrawal of the lidocaine infusion and administration of intravenous atropine (0.5 mg) rapidly restored sinus rhythm within 4 minutes.
- A gradual increase in blood pressure was observed over the subsequent 45 minutes.
- The patient recovered without evidence of a new myocardial infarction or lasting harm.
Implications:
- This case highlights a potential adverse effect of lidocaine, specifically sinus standstill and bradycardia, in patients with underlying cardiac disease.
- Prompt recognition and management with atropine can effectively reverse these life-threatening complications.
- Careful monitoring of patients on antiarrhythmic infusions is crucial, especially those with significant coronary artery disease.
Abstract:
A 60-year-old patient with coronary artery disease and antecedent (1976) myocardial infarction developed sinus standstill with nodal bradycardia of 41/min while on antiarrhythmic treatment with lidocain (2 mg/min drip infusion). Severe hypotension (70/50 mm Hg) occurred concomitantly. Withdrawal of lidocain and intravenous injection of 0.5 mg atropine restored sinus rhythm within 4 min, followed by a very sluggish, gradual increase in blood pressure over the next 45 minutes. Fortunately this episode did no harm to the patient. He was allowed to leave hospital 6 days later as there was no evidence of a second myocardial infarction and anginal pain was successfully controlled.