title: Refractory cardiogenic shock and complete heart block after unsuspected verapamil-SR and atenolol overdose.
abstract: A 57-year-old female presented with complete heart block and then developed refractory hypotension despite temporary pacing. Moderate left ventricular dysfunction with focal wall motion abnormalities, as well as severe hypoxemia, were demonstrated. However, neither significant coronary disease nor evidence for pulmonary embolus or other lung disease could be determined. Hemodynamic stabilization was achieved with the use of an intra-aortic balloon pump and multiple high-dose pressor agents. A retrospective diagnosis of toxic verapamil-SR and atenolol ingestion was confirmed, and the patient gradually recovered. The relevant literature is reviewed and various treatment approaches are discussed.
authors.affiliation: Department of Medicine, Salem Hospital, Oregon.
authors.forename: J
authors.initials: J
authors.lastname: Frierson
authors.forename: D
authors.initials: D
authors.lastname: Bailly
authors.forename: T
authors.initials: T
authors.lastname: Shultz
authors.forename: S
authors.initials: S
authors.lastname: Sund
authors.forename: A
authors.initials: A
authors.lastname: Dimas
mesh_terms: D001262:Atenolol / Q000506:poisoning*; D003692:Delayed-Action Preparations; D062787:Drug Overdose; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006327:Heart Block / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008875:Middle Aged; D011041:Poisoning / Q000150:complications*; D012770:Shock, Cardiogenic / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D013566:Sympathomimetics / Q000627:therapeutic use; D014700:Verapamil / Q000506:poisoning*
chemical_list: D003692:Delayed-Action Preparations; D013566:Sympathomimetics; D001262:Atenolol; D014700:Verapamil