Cardiogenic shock and disopyramide phosphate

DISOPYRAMIDE phosphate (Norpace) is a recently available antiarrhythmic drug. Although it has electrophysiologic properties similar to those of quinidine, disopyramide has gained popularity because of its fewer gastrointestinal side effects.1Toxicity has been reported to be primarily due to anticholinergic effects such as nausea and urinary retention.1The drug has also been reported to decrease cardiac output in patients with left ventricular dysfunction,1-3and toxic levels of the drug have been implicated as the cause of electrome-chanical dissociation and death in patients with severe heart failure and renal disease.4We describe here a patient in whom reversible cardiogenic shock developed after oral administration of disopyramide. Report of a Case A 49-year-old man with rheumatic valvular heart disease and suspected associated congestive cardiomyopathy was hospitalized in May 1978 for severe biventricular failure, complicated by a massive pulmonary embolus and frequent premature ventricular beats (PVBs). Discharge medications included