Point-of-Care Ultrasound Detection of Acute Myocardial Dysfunction Following Bupropion Overdose: A Case Report

Bupropion overdose is associated with significant morbidity and mortality due to severe neurologic and cardiovascular toxicity, including seizures and life-threatening arrhythmias.Early recognition of electrocardiographic, clinical, and echocardiographic abnormalities is critical for prompt intervention and prevention of clinical deterioration.We present a case of a 21-year-old female who presented to the emergency department following an intentional polysubstance overdose involving suspected bupropion ingestion.The initial electrocardiogram (EKG) demonstrated sinus tachycardia.However, during continued monitoring, the patient developed QRS widening and seizures.Treatment included benzodiazepines, calcium, and sodium bicarbonate.Point-ofcare ultrasound (POCUS) revealed a reduced ejection fraction (EF) of less than 30%, which was later confirmed on formal transthoracic echocardiography.These findings prompted escalation of care, intubation for airway protection and deep sedation, and transfer to the intensive care unit (ICU).During admission, she developed torsades de pointes (TdP), resulting in cardiac arrest.Despite her critical presentation, repeat echocardiography upon resolution of overdose toxicity demonstrated recovery of left ventricular systolic function, with improvement of EF to 50-55% during hospitalization.This case demonstrates the potential role of POCUS in the early recognition of myocardial dysfunction associated with bupropion toxicity.Together with serial EKG monitoring, these findings identified a patient at high risk for clinical deterioration and supported early escalation of care.