Cardiac arrest following isosorbide dinitrate transdermal patch misuse in a patient without a prescription history: A case report

Abstract

We report the case of a patient without a prescription history who experienced cardiac arrest following the misuse of isosorbide dinitrate transdermal patches. A 93-year-old male with atrial fibrillation and chronic heart failure experienced chest discomfort and became immobile while seeking medical attention, which prompted an emergency call. Upon arrival, the emergency medical team found that the patient was in shock with no palpable radial pulse and a Japan Coma Scale score of 100. Shortly after being loaded into the ambulance, the patient experienced cardiac arrest with an initial rhythm of pulseless electrical activity. Cardiopulmonary resuscitation was initiated, and spontaneous circulation was restored. The patient was transferred to the hospital with continuous intravenous administration of lactated Ringer’s solution and assisted ventilation.

On examination at the hospital, an abrasion was noted on the left elbow, where two 40 mg isosorbide dinitrate transdermal patches were applied. This was suspected to be the cause of the cardiac arrest, and the patches were immediately removed by the medical team. The patient showed no further deterioration in vital signs and was discharged on the fifth day of hospitalization. The patient misused the isosorbide dinitrate transdermal patches, which he had believed to be adhesive bandages. There was no prescription history for this patient, and their misuse was suspected to be due to the transfer of medication from another individual.