A Case of High Dose Metoprolol Poisoning; Case Report and Literature Review

Ocak, Metin; Çetinkaya, Halil; Kesim, Hüseyin

doi:10.54492/ijcmbs.v1i1.6

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…For bradycardia and shock, epinephrine and glucagon (if they are beta-blocker induced) can be considered. Glucagon reverses the beta blocker effect by activating adenylate cyclase, which causes an increase in cyclic adenosine monophosphate (cAMP) with a subsequent increase in intracellular calcium with enhanced depolarization and contractility [ 14 ]. If there’s no response to these measures, epinephrine can be considered, and it’s important to keep a low threshold for transcutaneous pacing [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Beta-Blocker and Calcium Channel Blocker Toxicity With BRASH Syndrome: A Case Report

Martínez¹,

Shah²,

Kim³

et al. 2023

Cureus

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Atrioventricular (AV) nodal blockers have a wide variety of medical uses, including the management of hypertension and cardiac arrhythmias. Like any other drug, they can carry side effects and toxicity. We present a case of a patient with a constellation of findings consistent with bradycardia, renal failure, AV nodal blockade, shock, and hyperkalemia (BRASH) syndrome. A 75-year-old female with a history of paroxysmal atrial fibrillation and heart failure with preserved ejection fraction presented to the hospital with shortness of breath. She was discharged two weeks prior to the presentation from another hospital after being treated for atrial fibrillation with a rapid ventricular response. She was discharged on metoprolol and diltiazem. Upon presentation to the hospital, the patient was noted to be bradycardic and hypotensive with blood work notable for acute kidney injury and hyperkalemia, consistent with BRASH syndrome. She received a dose of intravenous (IV) glucagon followed by infusion and received epinephrine infusion. Once clinically stable, she was discharged with her home dose of metoprolol and a reduced dose of diltiazem with a close follow-up with cardiology. Early recognition of BRASH syndrome as a unique clinical entity rather than different pathologic conditions is important to improve morbidity and mortality in these patients.

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Section: Discussionmentioning

confidence: 99%

Beta-Blocker and Calcium Channel Blocker Toxicity With BRASH Syndrome: A Case Report

Martínez¹,

Shah²,

Kim³

et al. 2023

Cureus

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“…Cardiac repolarization can traditionally be measured with QT interval, QT dispersion and corrected QT interval (QTc) from 12‐lead surface ECG. 3 , 4 , 5 On the other hands, frontal QRS‐T angle (fQRSTa) is a novel indicator of repolarization and depolarization heterogeneity. The relationship of the fQRSTa in many cardiovascular diseases has been investigated, and its importance in predicting cardiovascular arrhythmias has been demonstrated.…”

Section: Introductionmentioning

confidence: 99%

“…Cardiac repolarization abnormalities are one of them. Cardiac repolarization can traditionally be measured with QT interval, QT dispersion and corrected QT interval (QTc) from 12‐lead surface ECG 3–5 . On the other hands, frontal QRS‐T angle (fQRSTa) is a novel indicator of repolarization and depolarization heterogeneity.…”

Section: Introductionmentioning

confidence: 99%

The relationship between myocardial bridge and frontal QRS‐T angle

Taşçanov

Tanriverdi

Gungoren

et al. 2022

Journal of Arrhythmia

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Myocardial bridge (MB) is defined as the course of a part of the coronary artery within the myocardium. It is most common in the left anterior descending coronary artery. Although the incidence of MB has been reported as 0.5-16% in angiographic studies, it has been shown to reach up to 80% in autopsy studies. MB is known to benign course, but some adverse cardiac events have been reported associated with MB. Reported cardiac events have been shown to be associated with the effect of MB on coronary blood flow. Weakened myocardial blood flow in MB can cause mortal cardiac arrhythmias by impairing cardiac repolarization. 1

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