PubMed · 5704449
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R F Palmer. 1968. Antiarrhythmic agents.. https://doi.org/10.1097/00004311-196806010-00011
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HISTORY AND CLINICAL FINDINGS: A 52-year-old woman had for 31 years been experiencing occasional episodes of dizziness and syncope, as well as sudden attacks of "shaking" in the chest associated with cramp-like pain, nausea and weak spells, each lasting for up to 45 min. She had since childhood been suffering from atopy, with bronchial asthma and polyvalent allergies. On examination, which was otherwise unremarkable, her blood pressure was 140/100 mm Hg with a sinus tachycardia of 110/min. She was admitted for implantation of an event recorder to establish the etiology of the described symptoms. INVESTIGATIONS: The results of routine laboratory tests, including those of thyroid function, were within normal limits. The ECG showed sinus rhythm and minor left precordinal abnormalities of repolarization. The echocardiogram was normal and coronary angiography excluded coronary heart disease. TREATMENT AND COURSE: 3 weeks after ambulatory implantation of an event recorder (Reveal, Medtronic) she again had an attack. The recorded ECG indicated a supraventricular tachycardia (190/min), preceded by an atrial extrasystole, lasting 3 min 14 s. She was treated with digitalis and verapamil, her asthma contraindicating solatol. She had refused further invasive diagnostic measures. The appearance of an allergic rash required a change of drugs to propafenon. But as this, too, was poorly tolerated, electrophysiological testing was undertaken. It revealed an AV nodal reentry tachycardia which was treated with local ablation: supraventricular extrasystoles continued to occur frequently, but there were no further episodes of reentry tachycardia. CONCLUSION: In patients with recurrent syncopes, but otherwise unremarkable clinical findings, an implantable event recorder may provide important diagnostic information, especially relating to a possible arrhythmogenic cause.
BACKGROUND: Massive voluntary ingestion of cibenzoline causes major cardiotoxicity. We report on two cases where conventional treatments were ineffective. CASE REPORTS: Two patients were admitted to the intensive care unit of a University Hospital after massive voluntary intoxication with cibenzoline. Delay to admission after ingestion of cibenzoline was 1.5 and 4 hours. Circulatory impairment developed rapidly in both patients due to major atrioventricular and ventricular conduction disorders. Conventional intensive care procedures (sodium lactate and adrenaline) were performed but only provided temporary and incomplete efficacy. Outcome was fatal in both cases. DISCUSSION: The lethal potential of cibenzoline is very high. Extra-corporeal cardiocirculatory assistance might be an advisable measure if conventional therapy is unsuccessful. No clearly defined prognosis factors in cibenzoline intoxications have been reported.