Wenckebach Block - An ECG Presentation in Verapamil Poisoning

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 45; no. 4; p. 389
• Main Authors: Pereska, Z, Petkovska, L, Bozinovska, C, Petrovski, D, Licoska, F, Babulovska, A
• Format: Journal Article
• Language: English
• Published: 01.05.2007
• ISSN: 1556-3650

Objectives: Verapamil poisonings impair calcium-influx and induce profound negative inotropic effects, hypotension and reduced intracardiac conduction, particularly in SA and AV node. First, second and third degree A-V nodal block is the usual ECG presentation of this intoxication and indicates the severity of the poisoning. Case Report: A 29-year-old women was admitted to the Clinic with a history that 1 hour before she had ingested 20 tablets alprazolamum 0.5 mg and 12 film-coated tablets verapamil 80 mg in suicidal attempt She was somnolent, with TA 80/60 mm Hg, HR 68/min and ECG signs of A-V node block of 2nd degree (Wenckebach block - Mobitz I). Laboratory findings revealed no metabolic or electrolyte disturbances. Verapamil and benzodiazepines were qualitatively confirmed in chromatographic analysis of the urine. During the hospital stay HR fall to 50/min, with persisting signs of Wenckebach block on the monitor and TA decreased to 65/40 mm Hg. She was treated with activated charcoal, 10% CaCl sub(2), atropine, hypertonic glucose with insulin, dopamine and flumazenil. After 16h the ECG showed no signs of A-V block. One week later, 24-hour Hotter monitoring was obtained in the patient with no signs of A-V conduction abnormalities. Conclusion: Presentation of Wenckebach block in verapamil poisoning is a significant ECG parameter in diagnosing this intoxication. The possible progression of Mobitz I to complete A-V block indicates urgent treatment by taking all therapeutic measures to resolve this hemodinamic and intracardiac conduction inbalance.