Abstract:
:We report a case of potential cardiovascular toxicity including syncope, bradycardia, and ECG pauses associated with the use of rivastigmine and atenolol. A 65-year-old African American female with a medical history of dementia, hypertension, seizure disorder, stroke, and peripheral vascular disease was admitted to the hospital with shortness of breath and syncope. She was witnessed to have experienced a presyncopal episode followed by a true syncopal episode in which she was unresponsive for 20-30 s. On day two of hospital stay, the patient's ECG showed a sinus bradycardia with a heart rate in the 40 s and sinus pauses greater than 2 s in duration. Atenolol was immediately discontinued, with a continuance of the bradycardia despite one missed dose. The potentially toxic combination of rivastigmine and atenolol was then identified as a plausible causative factor of this patient's syncope and was subsequently discontinued. This patient's Naranjo adverse reaction probability score was five, which indicates a probable association between syncope and bradycardia with the combination of rivastigmine and atenolol [13]. Following the discontinuation of rivastigmine, the ECG pauses resolved and the patient's heart rate returned to normal levels. The patient did not experience any further dizziness or syncope. A 65-year-old female developed syncope and subsequent ECG pauses with sinus bradycardia after being treated with rivastigmine for dementia. Atenolol may have further compounded this toxic effect by its pharmacodynamic mechanisms.
journal_name
Cardiovasc Toxicoljournal_title
Cardiovascular toxicologyauthors
Paulison B,Léos CLdoi
10.1007/s12012-010-9088-5subject
Has Abstractpub_date
2010-12-01 00:00:00pages
306-10issue
4eissn
1530-7905issn
1559-0259journal_volume
10pub_type
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