engleski

Cardiac syncope as a side effect of topical administration anticholinergic drug

Tropicamide is a short-acting anticholinergic agent used for mydriasis in ophtalmology. Except local effect, administration in conjuctival bag can lead to systemic absorption through nasal mucose. Potential systemic side effects can be bradycardia and than tachycardia with palpitations and arrhythmias. We report a case of 74-years old female patient admitted in urgent unit unconscious, in sopor with unreactivated mydriatic pupils, hypotensive 100/70 mmHg and hypoxemic. The disturbance start after ophtalmology examination. After vertigo, she sudden lost of consciousness, without convulsive elements. Earlier she suffered from arterial hypertension, paroxysmal atrial fibrillation and initial psychoorganic changes and was treated with varfarin, ramipril and nebivolol. She was rehidrated and oxigenated. The urgent CT showed chronic ischaemic encephalopathy and ECG sinus tachycardia 100/min. During observation, after 15 minutes she completely recovered state of consciousness. Holter ECG, recorded the day earlier, showed paroxysmal atrial fibrillation and pause in heart rate duration 2.2 seconds. The internist excluded nebivolol and recommended cardiology control because eventually indication for pacemacer implantation. After 4 months, control holter ECG recorded short paroxysm of atrial fibrillation with maximum pause 1.9 seconds. There wasn't report od new loss od consciousness. The cardiology accompaniment was recomended. Our opinion is that the sustained syncope is caused by topical administration of tropicamide with systemic effect of tachycardia and consequently hypotension in patient with known cardiac arrythmia.

anticholinergic drug ; mydriasis ; ophtalmology ; syncope

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