title: Refractory cardiogenic shock and complete heart block after verapamil SR and metoprolol treatment. A case report.
abstract: A seventy-eight-year-old woman presented with complete heart block and refractory hypotension two days after a therapeutic dose of sustained-release verapamil with concomitant use of metoprolol. The patient continued to remain hypotensive with complete heart block, even with multiple uses of intravenous atropine as well as high doses of pressor agents such as dopamine and dobutamine. However, shortly after the use of intravenous calcium chloride, the refractory hypotension and complete heart block resolved.
authors.affiliation: Glendale Memorial Heart Center, California, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Lee
authors.forename: B
authors.initials: B
authors.lastname: Cohan
mesh_terms: D000368:Aged; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D004630:Emergencies; D005260:Female; D006327:Heart Block / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008790:Metoprolol / Q000009:adverse effects*; D012770:Shock, Cardiogenic / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D014700:Verapamil / Q000009:adverse effects*
chemical_list: D003692:Delayed-Action Preparations; D014700:Verapamil; D008790:Metoprolol