A case report of verapamil toxicity leading to haemodynamic compromise in obstructive hypertrophic cardiomyopathy

Jonathan W Gau; Florian Rader; Behram Mody; Andy Y Lee

doi:10.1093/ehjcr/ytae596

A case report of verapamil toxicity leading to haemodynamic compromise in obstructive hypertrophic cardiomyopathy

Eur Heart J Case Rep. 2024 Nov 20;8(12):ytae596. doi: 10.1093/ehjcr/ytae596. eCollection 2024 Dec.

Authors

Jonathan W Gau¹, Florian Rader², Behram Mody³, Andy Y Lee³

Affiliations

¹ Department of Internal Medicine, School of Medicine, University of California, Irvine, 101 City Dr S, Orange, CA 92868, USA.
² Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, 127 S San Vicente Blvd Pavilion Suite A3600, Los Angeles, CA 90048, USA.
³ Department of Medicine, Division of Cardiology, University of California, Irvine, 333 City Blvd W, Orange, CA 92868, USA.

Abstract

Background: Hypertrophic cardiomyopathy (HCM) is an inherited condition characterized by left ventricular (LV) hypertrophy unexplained by increased afterload, often with concomitant outflow tract obstruction. Verapamil is commonly used to treat symptomatic patients. However, its potential for adverse effects should be recognized.

Case summary: This report provides a case of cardiogenic shock in HCM, where a patient presented with chief complaint of fatigue and shortness of breath with an acute decline in LV systolic function on echocardiogram. His symptoms were attributed to verapamil toxicity following a recent increase in dosage. He achieved rapid symptom relief after holding his home medications, in addition to conservative management.

Discussion: This case report aims to elucidate the potential for multiple adverse effects involved with verapamil use in patients with obstructive HCM.

Keywords: Case report; Echocardiogram; Obstructive hypertrophic cardiomyopathy; Verapamil toxicity.

Publication types

Case Reports