Auto-intoxication with flecainide and quinapril: ECG-changes, symptoms and treatment.
Flecainide acetate is a sodium channel blocker and a class Ic antiarrhythmic agent with potential life-threatening proarrhythmic and cardioinhibitory properties when taken in overdose. Quinapril is an angiotensin-converting enzyme inhibitor (ACE-inhibitor) and overdose can lead to prolonged hypotension and, less frequently, transient renal impairment. We describe the first published case of intoxication with both drugs. The patient developed a broad-QRS-tachycardia and severe hypotension. Treatment with volume expansion, hypertonic sodium bicarbonate, inotropic support with norepinephrine and insertion of an intra-aortic balloon pump led to complete recovery after 72 hours. We assume that the clinical picture was mainly dictated by flecainide intoxication. Relevant literature data are discussed.
Van Reet
Bert
B
Department of Cardiology, Hospital Oost-Limburg, Gen, Belgium.
Dens
Joseph
J
D000293:Adolescent; D001794:Blood Pressure / Q000187:drug effects; D004562:Electrocardiography; D005260:Female; D005424:Flecainide / Q000009:adverse effects / Q000378:metabolism* / Q000494:pharmacology; D006801:Humans; D000077583:Quinapril; D013610:Tachycardia / Q000188:drug therapy / Q000473:pathology; D044005:Tetrahydroisoquinolines / Q000009:adverse effects / Q000378:metabolism* / Q000494:pharmacology
D044005:Tetrahydroisoquinolines; D005424:Flecainide; D000077583:Quinapril