Key result
Additional therapy with levosimendan led to rapid clinical improvement in a 60-year-old patient with severe verapamil intoxication refractory to standard high-dose inotropes.
Why the study?
Does levosimendan improve clinical status in patients with severe verapamil intoxication presenting with cardiovascular shock refractory to standard management?
Case Report (n=1)
Does levosimendan improve clinical status in patients with severe verapamil intoxication presenting with cardiovascular shock refractory to standard management?
Levosimendan may serve as an effective rescue therapy for patients with cardiovascular shock due to severe verapamil intoxication who are refractory to standard resuscitation methods.
Answers are grounded in this paper and cite their sources.
May support levosimendan rescue in refractory verapamil shock; hypothesis-generating and requires prospective validation before adoption.
Cardiovascular shock due to verapamil intoxication is often refractory to standard resuscitation methods. Recommended therapy includes prevention of further absorption of the drug, inotropic therapy, calcium gluconate, and hyperinsulinemia/euglycemia therapy. Often further measures are needed such as ventricular pacing or mechanical circulatory support. Still, mortality remains high. Levosimendan, an inotropic agent, that enhances myofilament response to calcium, increases myocardial contraction and could therefore be beneficial in verapamil intoxication. Here, we report the case of a 60-year-old patient with clinically severe verapamil poisoning who presented with shock, bradycardia, and sopor. Standard therapy including high-dose inotropes failed to ameliorate the signs of intoxication. But additional therapy with levosimendan led to rapid improvement. Based on this observation, the literature is reviewed focusing on utilization of levosimendan in the treatment of calcium channel blocker overdose. We suggest to consider levosimendan as additional treatment option in patients with cardiovascular shock due to verapamil intoxication that are refractory to standard management.
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Osthoff et al. (2010) conducted a case report in Severe verapamil intoxication (n=1). Levosimendan vs. Standard therapy (high-dose inotropes) was evaluated on Clinical improvement. Additional therapy with levosimendan led to rapid clinical improvement in a 60-year-old patient with severe verapamil intoxication refractory to standard high-dose inotropes.
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