Department 4 Cardio-Thoracic Pathology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania.
Medicina (Kaunas). 2022 Dec 2;58(12):1777. doi: 10.3390/medicina58121777.
β-blocker poisoning is frequently observed because of its primary use for the treatment of cardiovascular diseases. The management of β-blocker toxicity is dependent on the cardiovascular response and the severity of presentation. The present study describes the case of a patient with combined drug intoxication, β-blocker, digoxin, benzodiazepines, acetaminophen and opiates in a suicidal attempt. A 63-year-old female was found somnolent and in a confused state at her residence following intentional poly-drug ingestion. Upon presentation, she was found to be hemodynamically unstable and was thus treated with vasopressors. The toxicological screening performed upon presentation was positive for polydrug ingestion. On day 3, the patient developed chest pain and ST-segment elevation in anterior leads, while transthoracic echocardiographic assessment disclosed a non-dilated left ventricle with moderate dysfunction and akinesia of the apex. Coronary angiogram revealed normal coronary arteries and, subsequently, the diagnosis of Takotsubo cardiomyopathy (TTC) was suspected. Supportive treatment was initiated with favorable evolution and left ventricular ejection fraction normalization. The management of hemodynamic instability with vasopressors should be judiciously administered in the treatment of β-blocker poisoning, in view of the adverse effects on cardiac functions, including stress cardiomyopathy.
β受体阻滞剂中毒很常见，因为它主要用于治疗心血管疾病。β受体阻滞剂毒性的处理取决于心血管反应和表现的严重程度。本研究描述了 1 例患者在自杀企图中合并药物中毒，包括β受体阻滞剂、地高辛、苯二氮䓬类、对乙酰氨基酚和阿片类药物。1 名 63 岁女性在其住所被发现昏睡和意识混乱，随后被发现为故意多药摄入。就诊时发现患者血流动力学不稳定，因此给予血管加压药治疗。就诊时进行的毒理学筛查显示存在多种药物摄入。第 3 天，患者出现胸痛和前导导联 ST 段抬高，而经胸超声心动图评估显示左心室不扩张，中度功能障碍，心尖运动障碍。冠状动脉造影显示正常冠状动脉，随后怀疑 Takotsubo 心肌病（TTC）。给予支持性治疗，病情进展良好，左心室射血分数恢复正常。在治疗β受体阻滞剂中毒时，应谨慎使用血管加压药来治疗血流动力学不稳定，因为这会对心脏功能产生不良影响，包括应激性心肌病。
