title: Potential for Infra-Nodal Heart Block and Cardiogenic Shock With Propofol Administration.
abstract: We report a case of infra-nodal complete heart block and cardiogenic shock in a previously healthy 64-year-old man after administration of 180 mg of intravenous Propofol. Although bradycardia, hypotension, and heart block are commonly seen with propofol administration, such findings are transient and respond quickly to administration of vagolytic or sympathomimetic agents suggesting an AV nodal mechanism of heart block. Sustained left ventricular systolic dysfunction and cardiogenic shock by an alternative, non-autonomic mechanism has also been described in the setting of Propofol administration. Our case is the first to note sustained complete infra-nodal heart block in this setting. Early recognition of such a complication, restoration of atrio-ventricular (A-V) synchrony with dual chamber pacing, and aggressive circulatory support is essential in bridging such patients to recovery.
authors.affiliation: Saint Louis University, Department of Cardiology, 3635 Vista Avenue, Saint Louis, MO, 63110-0250, 13th floor Desloge Tower, 63110-0250, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Olson
authors.affiliation: Saint Louis University, Department of Cardiology, 3635 Vista Avenue, Saint Louis, MO, 63110-0250, 13th floor Desloge Tower, 63110-0250, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lim
authors.affiliation: Saint Louis University, Department of Cardiology, 3635 Vista Avenue, Saint Louis, MO, 63110-0250, 13th floor Desloge Tower, 63110-0250, USA.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Ferreira
authors.affiliation: Saint Louis University, Department of Cardiology, 3635 Vista Avenue, Saint Louis, MO, 63110-0250, 13th floor Desloge Tower, 63110-0250, USA.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Mehdirad
keywords: Anesthesia; Cardiogenic shock; Cardiomyopathy; Heart block; Heart failure; Hypotension; Impella; Left ventricular assist device; Propofol; Propofol infusion syndrome