Electromechanical Dissociation following Verapamil and Propranolol Ingestion: A Physiologic Profile

Abstract

We present a case of combined verapamil and propranolol ingestion in a young woman with a DDD pacer from whom hemodynamic, echocardiographic, and toxicologic data were obtained simultaneously. Analysis of the data from these combined sources suggests a progression of (1) recovery of myocardial contractility, (2) return of systemic vascular resistance, and (3) return of intrinsic electrical activity of the heart. That contractility returns before intrinsic electrical activity strongly for the early use of transvenous temporary pacing wires. Furthermore, our patient’s complete recovery after a prolonged electromechanical dissociation arrest would again argue for very aggressive resuscitation efforts in this setting.

Neurological Recovery after Prolonged Verapamil-Induced Cardiac Arrest

“…It is rarely possible to study their effects prior to cerebral ischaemia in humans. The occasional case report such as this and another 21 in which the patient made a full neurological recovery following 45 minutes of CPR suggest that verapamil overdose may confer some degree of protection from the effects of cerebral ischaemia.…”

Late Onset, Prolonged Asystole Following Organophosphate Poisoning: A Case Report

“…We believe that uninterrupted, effective CPR was probably responsible for the good outcome in our case. There have been other reports of complete neurological recovery after cardiotoxic drugs, especially calcium channel blockers [19][20][21].…”