Key result
Diphenhydramine overdose linked to subtle LV dysfunction with reduced GLS of -13% despite preserved LVEF.
Why the study?
Left ventricular systolic dysfunction is a manifestation of diphenhydramine toxicity that may not be detected by ECG or ejection fraction assessment alone.
Does point-of-care echocardiography with speckle tracking detect subtle LV systolic dysfunction in a patient with diphenhydramine overdose and a normal ECG?
Case Report (n=1)
Does point-of-care echocardiography with speckle tracking detect subtle LV systolic dysfunction in a patient with diphenhydramine overdose and a normal ECG?
Global longitudinal strain via point-of-care echocardiography can detect subtle left ventricular systolic dysfunction in diphenhydramine overdose patients even when ECG and ejection fraction are normal.
Speckle-tracking echocardiography may detect subclinical LV dysfunction in diphenhydramine overdose; hypothesis-generating and should not yet change practice.
Diphenhydramine overdose is a dangerous condition that typically leads to symptoms of antimuscarinic toxicity and dysrhythmias. Left ventricular (LV) systolic dysfunction is a manifestation of diphenhydramine toxicity that commonly presents with electrocardiogram (ECG) findings of QRS prolongation. This article presents the case of a patient who was brought to the emergency department (ED) after a diphenhydramine overdose and was showing signs of antimuscarinic toxicity, with an ECG showing no signs of QRS interval prolongation. Point-of-care echocardiography and speckle tracking were performed, which showed a preserved ejection fraction (EF) and reduced global longitudinal strain (GLS), suggestive of subtle LV systolic dysfunction. The patient was treated with intravenous fluids and rivastigmine; his symptoms improved appropriately, and he was discharged the following day. This case report highlights the sensitivity of GLS in unveiling LV systolic dysfunction in patients with preserved EF and a normal ECG, showing its potential utility in patients presenting to the ED with substance overdoses.
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Kidess et al. (2026) conducted a case report in Diphenhydramine overdose (n=1). Diphenhydramine overdose was evaluated on Left ventricular systolic dysfunction measured by global longitudinal strain (GLS). Diphenhydramine overdose was associated with subtle left ventricular systolic dysfunction, detected by a reduced global longitudinal strain of -13% despite a normal electrocardiogram and preserved ejection fraction.
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