Salbutamol overdose
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Tachycardia in a child with cardiac displacement: case report A 3-year-old girl, who had cardiac displacement, developed narrow QRS tachycardia following an unintentional overdose of salbutamol. The girl accidently ingested salbutamol [albuterol] 24mg, and was admitted. Her HR was 195 beats/min. She had narrow QRS complexes that were each preceded by a P wave that was negative in leads I and aVL, and positive in lead V1 and the inferior leads [time to reaction onset not stated]. Her P waves had a constant P-R interval of 120 msec and a P wave axis of around +150°. Based on these findings, her most likely diagnosis was ectopic atrial tachycardia arising from the left atrium. Her ventricular complexes were abnormal because leads I, II, and aVL showed a qR configuration with deep q waves; additionally, all her chest leads reflected narrow and deep Q waves followed by relatively tall R waves. There was an S wave only in leads V4R and V1. Her parents revealed that she had right lung agenesis; chest x-ray showed complete displacement of her heart to her right chest. Therefore, it was hypothesised that both her unexpected QRS morphology and her abnormal P wave axis resulted from her marked cardiac displacement. Subsequently, based on the large amount of salbutamol ingested, a diagnosis of sinus tachycardia was considered. The girl received propranolol, and her HR progressively decreased to around 100 beats/min; her P wave and QRS complex configuration remained unchanged. On follow-up over 6 months, her ECGs always showed the same P wave axis and configuration as during tachycardia. Author comment: "Although it is theoretically possible that the patient had a persistent left atrial rhythm both at rest and during salbutamol-induced tachycardia, it is more likely that sinus rhythm resulted in abnormal P wave axis and configuration due to the extremely abnormal heart position; when sinus tachycardia occurred, the pattern mimicked an ectopic tachycardia arising from the left atrium. The dextroposition of the heart also explains the uncommon QRS complex configuration." Calabr`o MP, et al. Salbutamol-induced narrow QRS tachycardia: what is the mechanism? Journal of Cardiovascular Electrophysiology 17: 792-793, No. 7, Jul 801044197 2006 - Italy
0114-9954/10/1120-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 23 Sep 2006 No. 1120
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