Junctional bradycardia caused by ciguatera intoxication

Raman, Rajendra; Coppes, Sarah; Hellingman, Tessa; Laclé, Casper

doi:10.1136/bcr-2019-229354

Cited by 4 publications

(6 citation statements)

References 8 publications

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“…A junctional rhythm is described as a cardiac rhythm originating from the atrioventricular node or bundle of His as opposed to the sinoatrial node [ 9 ]. Causes of junctional bradycardia include ischemia of the atrioventricular node, electrolyte abnormalities, drug toxicities, myocarditis, and infections like Chagas disease and Lyme disease [ 10 ]. Our patient’s troponin levels were within normal range and there were no characteristics of ischemia on EKG.…”

Section: Discussionmentioning

confidence: 99%

“…Phenytoin has a narrow therapeutic window and wide inter-individual metabolic variability [ 10 ]. Oral phenytoin is absorbed in the gut and metabolized in the liver.…”

Section: Discussionmentioning

confidence: 99%

“…Oral phenytoin is absorbed in the gut and metabolized in the liver. The most common causes of elevated phenytoin levels include excessive self-medication, misunderstanding prescription orders, drug interactions, and unknown causes [ 10 ]. Drugs such as folic acid, dexamethasone, and rifampicin have been known to increase phenytoin serum levels [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case of Junctional Bradycardia Secondary to Oral Phenytoin

Niazi¹,

Trivedi²,

Perrella³

2022

Cureus

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Phenytoin is a commonly used anti-seizure agent, which stabilizes neuronal membranes by blocking voltage-gated sodium channels to inhibit the propagation of action potentials during convulsions. However, phenytoin has also been shown to have antiarrhythmic effects as it can prolong the effective refractory period of ventricular pacemaker cells. Adverse cardiac effects such as junctional bradycardia are usually seen with intravenous use. Cardiovascular dysfunction is not well recognized in oral phenytoin toxicity. Here we present a case of junctional bradycardia due to oral phenytoin toxicity, which resolved spontaneously with the discontinuation of phenytoin. This case report will serve to increase awareness of the adverse cardiovascular effects of oral phenytoin toxicity to improve the recognition and treatment of these adverse effects.

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Section: Discussionmentioning

confidence: 99%

“…Phenytoin has a narrow therapeutic window and wide inter-individual metabolic variability [ 10 ]. Oral phenytoin is absorbed in the gut and metabolized in the liver.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Rare Case of Junctional Bradycardia Secondary to Oral Phenytoin

Niazi¹,

Trivedi²,

Perrella³

2022

Cureus

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“…Cardiovascular manifestations: These are the least frequent but the most feared, usually starting 2 and 3 days after consumption [ 32 ]. The toxin has a direct effect on the papillary muscles and on the atrium, therefore predisposing the patient to presenting cardiac arrhythmias, extrasystoles and heart failure that can be potentially lethal.…”

Section: Pathophysiologymentioning

confidence: 99%

Epidemiology and Toxicology of Ciguatera Poisoning in the Colombian Caribbean

et al. 2020

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Ciguatera is a food intoxication caused by the consumption of primarily coral fish; these species exist in large numbers in the seas that surround the Colombian territory. The underreported diagnosis of this clinical entity has been widely highlighted due to multiple factors, such as, among others, ignorance by the primary care practitioner consulted for this condition as well as clinical similarity to secondary gastroenteric symptoms and common food poisonings of bacterial, parasitic or viral etiology. Eventually, it was found that people affected by ciguatoxins had trips to coastal areas hours before the onset of symptoms. Thanks to multiple studies over the years, it has been possible to identify the relation between toxigenic dinoflagellates and seagrasses, as well as its incorporation into the food chain, starting by fish primarily inhabiting reef ecosystems and culminating in the intake of these by humans. Identifying the epidemiological link, its cardinal symptoms and affected systems, such as gastrointestinal, the peripheral nervous system and, fortunately with a low frequency, the cardiovascular system, leads to a purely clinical diagnostic impression without necessitating further complementary studies; in addition, what would also help fight ciguatera poisoning is performing an adequate treatment of the symptoms right from the start, without underestimating or overlooking any associated complications.

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“…Cardiovascular Manifestation : they are the least frequent but the most feared, usually start 2 and 3 days after consumption [30]. The toxin has a direct effect on the papillary muscles and on the atrium therefore predisposes the patient to presenting cardiac arrhythmias, extrasystoles and heart failure that can be potentially lethal.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Epidemiology and Toxicology of Ciguatera Poisoning in the Colombian Caribbean

Quiroz

Herrera-Usuga

Osorio-Ospina

et al. 2020

Preprint

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The ciguatera is a food poisoning caused by the consumption of primarily coral fish; these species exist in large numbers in the seas that bathe the Colombian territory. The underreported diagnosis of this clinical entity has been widely highlighted due to multiple factors, as are among others, ignorance by the primary care practitioner consulted for this condition, clinical similarity with secondary gastroenteric symptoms, to common food poisonings of bacterial, parasitic or viral etiology. Eventually people affected by ciguatotoxin are related to trips to coastal areas hours before the onset of symptoms. Thanks to multiple studies over the years it has been possible to identify the relation of the dinoflagellates in the assembly of said toxin and its introduction into the food chain, starting by fish primarily inhabiting reef ecosystems and culminating in the intake of these by humans. Identifying the epidemiological link, its cardinal symptoms and affected systems such as gastrointestinal, peripheral nervous system and fortunately with a low frequency, the cardiovascular system, leads to a purely clinical diagnostic impression without further complementary studies, performing an adequate treatment primarily symptomatic without underestimating or overlooking any associated complications.

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Junctional bradycardia caused by ciguatera intoxication

Cited by 4 publications

References 8 publications

A Rare Case of Junctional Bradycardia Secondary to Oral Phenytoin

A Rare Case of Junctional Bradycardia Secondary to Oral Phenytoin

Epidemiology and Toxicology of Ciguatera Poisoning in the Colombian Caribbean

Epidemiology and Toxicology of Ciguatera Poisoning in the Colombian Caribbean

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