Cardiovascular manifestations in aluminium phosphide poisoning with special reference to echocardiographic changes

Twenty five patients of aluminium phosphide poisoning along with clinical evidence of peripheral circulatory failure were studied. Chief symptoms noted were vomiting and epigastric pain though subsequently three patients developed respiratory distress. Sensorium was normal in most of the patients. Three patients developed pulmonary edema. Raised JVP, feeble heart sounds and S3 gallop beside tachy and bradycardia were other cardiovascular manifestations observed in these patients. In 80% of the patients, various types of ECG changes were observed. ST-T changes were observed in 40% of the patients. Echo-cardiography on day 1 revealed marked LV systolic dysfunction (mean ejection fraction-43.52 +/- 10.18% and mean fractional shortening 17.35 +/- 4.97%) in them whereas repeat echocardiography on day 5 indicated normalisation of these values (mean ejection fraction 71.64 +/- 8.61% and mean fractional shortening 34.35 +/- 8.23%). This might be because of direct toxic action of phosphine on myocardium and later when phosphine gets excreted either through lungs or kidney leads to improvement in LV systolic function.