Isolated Tramadol Overdose Associated with Brugada ECG Pattern

Abstract

Tramadol is a commonly prescribed synthetic opioid analgesic. In humans, electrocardiogram (ECG) changes consistent with sodium-channel blockade have not been described in overdoses with tramadol. We report a case of isolated tramadol overdose associated with a Brugada ECG pattern. A review of the literature reveals no previous human cases of tramadol overdose causing ECG changes consistent with sodium-channel blockade. However, in vitro blockade of sodium-channels has been demonstrated with high concentrations of tramadol. Tramadol overdose should be recognized as a cause for the manifestation of a Brugada ECG pattern in the setting of suicidal intoxication.

Electrocardiographic changes in patients with tramadol-induced idiosyncratic seizures

“…In majority of toxicities, no arrhythmia was reported except to tachycardia 8 . There are a few case reports of Brugada ECG pattern, right-sided heart failure (HF), refractory shock, and asystole 12, 13, 14. Interestingly, hypertension is seen in some cases 5 .…”

“…Nausea/vomiting and respiratory depression have also been reported 5, 7, 8. Of cardiac issues, hypotension, especially affecting systolic blood pressure (SBP) and sinus tachycardia have been listed as tramadol toxicity complications 5, 7, 8, 12, 13, 14…”

Conduction Disturbances and Ventricular Arrhythmias Associated with High- Dose Loperamide

“…The unmasking of the Brugada pattern (often provoked with agents such as cocaine, propofol, tricyclic antidepressants, anesthetics, antiarrhythmic medications, as well as fever or electrolyte imbalance) has been highly-associated with risk for malignant arrhythmias and cardiac arrest [13]. The appearance of a Brugada pattern has been reported in the context of opiate use, such as methadone ingestion and tramadol overdose in previously-published cases [14,15]. The observation of QRS prolongation and Brugada pattern with high serum loperamide concentration suggests potential of sodium channel blockade in a manner similar to Class I antiarrhythmic medications.…”

Brugada Phenocopy in Concomitant Ethanol and Heroin Overdose

“…6 Cole et al reported an asymptomatic Brugada-like ECG pattern associated with isolated tramadol overdose. 7 Authors hypothesize that tramadol blockade of sodium channels might be the cause of observed ECG changes.…”