Recalcitrant Supraventricular Tachycardia: Occult Albuterol Toxicity Due to a Factitious Disorder

Wills, Brandon K.; Kwan, Constance; Bailey, Michael; Johnson, Leigh G.; Allan, Nicholas

doi:10.1016/j.jemermed.2015.05.007

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…Several extreme NCCP-related case reports exist, including a patient who feigned aortic dissection and underwent thoracotomy, and a patient who induced a recalcitrant supraventricular tachycardia with surreptitious albuterol misuse over several years. 50,51 In a study of factitious disorder, nearly 5% of cases were referred from cardiology. 52 …”

Section: The Psychiatric Differential Diagnosismentioning

confidence: 99%

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

et al. 2017

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Background Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patients experiencing non-cardiac chest pain (NCCP) suffer significant disability. In light of emerging evidence that mental health providers can serve a key role in the care of patients with NCCP, knowledge of the differential diagnosis, psychiatric co-morbidities, and therapeutic techniques for NCCP would be of great use to both consultation-liaison (C-L) psychiatrists and other mental health providers. Methods We reviewed prior published work on (1) the appropriate medical workup of the acute presentation of chest pain, (2) the relevant medical and psychiatric differential diagnosis for chest pain determined to be non-cardiac in origin, (3) the management of related conditions in psychosomatic medicine, and (4) management strategies for patients with NCCP. Results We identified key differential diagnostic and therapeutic considerations for psychosomatic medicine providers in 3 different clinical contexts: acute care in the emergency department, inpatient C-L psychiatry, and outpatient C-L psychiatry. We also identified several gaps in the literature surrounding the short-term and long-term management of NCCP in patients with psychiatric etiologies or co-morbid psychiatric conditions. Conclusions Though some approaches to the care of patients with NCCP have been developed, more work is needed to determine the most effective management techniques for this unique and high-morbidity population.

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Section: The Psychiatric Differential Diagnosismentioning

confidence: 99%

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

et al. 2017

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“…One case was documented of a 26-year-old woman who presented multiple times to the emergency department with supraventricular tachycardia and transient hypokalaemia over a 3-year-period from salbutamol (albuterol) misuse. [4] This patient was also eventually lost to follow-up. There have also been reported cases of surreptitious use of loop and thiazide diuretics leading to the mistaken initial diagnosis of Bartter's syndrome [5] and Gitelman syndrome respectively.…”

Section: Discussionmentioning

confidence: 99%

Biochemical munchausen’s - a “baffling” case of recurrent hypokalemia and lactic acidosis - secondary to surreptitious salbutamol abuse in a 36-year-old female

Chen

Ray

Jacobson

et al. 2016

CRIM

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Factitious medical disorders with the well-known eponym of Munchausen's syndrome represent a challenge in both diagnosis and management for the clinician. Here, we report a case of "Biochemical Munchausen's" in a 36-year-old female, characterised by recurrent and multiple presentations with symptomatic hypokalaemia, supraventricular tachycardia and lactic acidosis that required the use of biochemical laboratory expertise and liquid chromatography/mass spectrophotometry to unravel and break the cycle of costly investigations and hopefully contain the risk of potential harm. We also highlight the evolution of various stages of generating factitious illness in this 36-year-old female with the crucial breakthrough being made only by proof of the biochemical exposure through the close collaboration of biochemist and clinicians.

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“…119,120 Rarely, dysrhythmias including atrial fibrillation have been documented and in exceptional cases, acute myocardial infarction was observed. [121][122][123][124][125] The latter is more relevant in the case of clenbuterol, a drug used to enhance performance in sports. The underlying mechanism can also involve spasm of coronary arteries and/or temporary thrombosis.…”

Section: Nonselective -Agonists and 2 -Agonistsmentioning

confidence: 99%

“…Indeed, palpitations and sinus tachycardia are relatively common . Rarely, dysrhythmias including atrial fibrillation have been documented and in exceptional cases, acute myocardial infarction was observed . The latter is more relevant in the case of clenbuterol, a drug used to enhance performance in sports.…”

Section: Drugs With Possible Toxic Effects On Both Cardiomyocytes Andmentioning

confidence: 99%

Comprehensive review of cardiovascular toxicity of drugs and related agents

Mladěnka

Applová

Patočka

et al. 2018

Medicinal Research Reviews

203

120

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Cardiovascular diseases are a leading cause of morbidity and mortality in most developed countries of the world. Pharmaceuticals, illicit drugs, and toxins can significantly contribute to the overall cardiovascular burden and thus deserve attention. The present article is a systematic overview of drugs that may induce distinct cardiovascular toxicity. The compounds are classified into agents that have significant effects on the heart, blood vessels, or both. The mechanism(s) of toxic action are discussed and treatment modalities are briefly mentioned in relevant cases. Due to the large number of clinically relevant compounds discussed, this article could be of interest to a broad audience including pharmacologists and toxicologists, pharmacists, physicians, and medicinal chemists. Particular emphasis is given to clinically relevant topics including the cardiovascular toxicity of illicit sympathomimetic drugs (e.g., cocaine, amphetamines, cathinones), drugs that prolong the QT interval, antidysrhythmic drugs, digoxin and other cardioactive steroids, beta‐blockers, calcium channel blockers, female hormones, nonsteroidal anti‐inflammatory, and anticancer compounds encompassing anthracyclines and novel targeted therapy interfering with the HER2 or the vascular endothelial growth factor pathway.

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Recalcitrant Supraventricular Tachycardia: Occult Albuterol Toxicity Due to a Factitious Disorder

Cited by 9 publications

References 11 publications

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

Biochemical munchausen’s - a “baffling” case of recurrent hypokalemia and lactic acidosis - secondary to surreptitious salbutamol abuse in a 36-year-old female

Comprehensive review of cardiovascular toxicity of drugs and related agents

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