Abstract
We describe a rare case of carvedilol and propafenone toxicity. An 80 years-old woman receiving cardiopulmonary resuscitation for cardiac arrest was admitted to our emergency room. She had a history of hypertension, paroxysmal atrial fibrillation and dementia. Cardiopulmonary resuscitation was continued along with adrenaline injection. Although she was successfully resuscitated, her heart rate immediately decreased to 10-20 /min. She received a continuous infusion of adrenaline. Moreover, a temporary pacing electrode was inserted, but pacing frequently failed. Within 10 hours, the hemodynamics became stable with a heart rate of 70 /min. Thereafter, the adrenaline infusion was stopped, and the pacing electrode was removed. Based on the medical records, we noted that she had been prescribed carvedilol, olmesartan, azelnidipine and propafenone, and she had taken many prescriptions simultaneously. The plasma concentrations of propafenone and 5-OH propafenone were higher than their therapeutic doses. Hence the cardiac arrest followed by severe bradycardia and pacing failure may be due to the overdose of carvedilol and propafenone. For old age, propafenone might induce toxicity and cardiac arrest easily.
