Toxic Myocarditis Caused by Acute Organophosphate Poisoning

We report the case of a 69-year-old woman who developed acute organophosphate poisoning with myocardial damage following ingestion of 11.5g of disulfoton in a suicide attempt. An initial ECG showed complete atrioventricular block with premature ventricular contractions. Abnormal Q waves appeared in...

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Bibliographic Details
Published in:Nihon Kyukyu Igakukai Zasshi 1993/08/15, Vol.4(4), pp.359-363
Main Authors: Masuda, Takashi, Sawada, Yumiko, Tsutsumi, Kunihiko, Tsuchiya, Naotaka, Yokouchi, Satoko, Ohwada, Takashi, Kuwao, Sadahito
Format: Article
Language:English
Subjects:
arrhythmia
myocardial biopsy
myocardial damage
myocarditis
organophosphate poisoning
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Summary:We report the case of a 69-year-old woman who developed acute organophosphate poisoning with myocardial damage following ingestion of 11.5g of disulfoton in a suicide attempt. An initial ECG showed complete atrioventricular block with premature ventricular contractions. Abnormal Q waves appeared in leads II, III, aVF and V1 to V6 and ST elevations developed in leads of aVL and V1 to V6 on the 2nd hospital day. We demonstrated reversible left ventricular wall asynergy on a 2-dimensional echocardiogram. The blood concentration of organophosphate, measured as dichlorvos, was 3.51μg/ml on admission and we found no significant increase in serum viral antibody titers during hospitalization. Coronary angiography revealed no abnormalities and the acetylcholine provocation test was negative. Biopsied left ventricular myocardium showed severe hydropic swelling and nuclear pyknosis associated with interstitial edema which suggested direct toxic action of organophosphate. The lesion was consistent with “toxic myocarditis”.
ISSN:0915-924X
1883-3772
DOI:10.3893/jjaam.4.359