title: Cardiac abnormalities in severe acute dichlorvos poisoning.
abstract: OBJECTIVE
  Patients with organophosphorus poisoning sometimes die suddenly during rigorous treatment, possibly from myocardial injury. This study sought to elucidate the mechanisms underlying organophosphorus poisoning-induced cardiotoxicity.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Urban, tertiary teaching hospital emergency intensive care unit with 10 beds.
  
  
  METHODS
  Forty-one patients with severe acute dichlorvos poisoning were consecutively enrolled (n = 92) at emergency intensive care unit and followed for 3 months.
  
  
  RESULTS
  Levels of serum creatine kinase isoenzyme myocardium, cardiac troponin I, acetylcholinesterase, acetylcholine, epinephrine, and norepinephrine were tested on hospital days 1, 3, and 5 and on discharge day. Electrocardiography was recorded on admission and then every other day. Transthoracic echocardiography was performed at admission, in the acute phase, before discharge, and during follow-up. Technetium 99m-sestamibi myocardial single photon emission computed tomography was conducted in four patients. Thirty-seven (90.2%) patients survived and four (9.8%) patients died during treatment. We observed sinus tachycardia in 37 (90.2%) patients and ST-T changes in 33 (80.4%) patients. Creatine kinase isoenzyme myocardium and cardiac troponin I levels peaked at day 3 postadmission and then decreased to normal levels. Serum acetylcholine, epinephrine, and norepinephrine peaked at day 1 after admission and then decreased. Echocardiography revealed marked decreases in wall motion of the interventricular septum and left ventricle in the acute phase but returned to normal in the recovery phase. The left ventricular ejection fraction improved significantly from 42 ± 5% to 59 ± 4% (p = .001). Single photon emission computed tomography showed abnormal left ventricle perfusion.
  
  
  CONCLUSIONS
  Severe acute dichlorvos poisoning is associated with reversible myocardial dysfunction, possibly through an increase in catecholamine levels.
authors.affiliation: Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Xinhua
authors.initials: X
authors.lastname: He
authors.forename: Chunsheng
authors.initials: C
authors.lastname: Li
authors.forename: Dongmei
authors.initials: D
authors.lastname: Wei
authors.forename: Junyuan
authors.initials: J
authors.lastname: Wu
authors.forename: Luhui
authors.initials: L
authors.lastname: Shen
authors.forename: Tie
authors.initials: T
authors.lastname: Wang
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis*; D002395:Catecholamines / Q000032:analysis / Q000097:blood; D002423:Cause of Death; D002681:China; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D004006:Dichlorvos / Q000506:poisoning*; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010575:Pesticides / Q000506:poisoning*; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult
chemical_list: D002395:Catecholamines; D010575:Pesticides; D004006:Dichlorvos