OBJECTIVE:Arrhytmias due to electrical instability, excess sympathetic tone, and bradyarrhytmias are associated with ST- elevation myocardial infarction (STEMI). On the other hand, propafenone is a class I antiarrhythmic medication widely used for the treatment of arrhythmias, particularly paroxysmal episodes of atrial fibrillation. It has sodium channel blockade activity along with β-adrenergic blocking activity. We will report an acute coronary syndrome case presented with nausea and vomiting, with a history of recent propafenone overuse.

CASE:An 88-year-old female was admitted to the emergency department with a complaint of vomiting. The patient stated that she had been having palpitations and had taken 6 tablets of her antiarrhythmic drugs, each containing 150 propafenone, to avoid. Soon after taking the pills, she experienced a near-syncope. On admission, she denied shortness of breath or chest pain. The electrocardiogram (ECG) revealed a 30 bpm idioventricular rhythm accompanied by right ventricular STEMI features, with the absence of P waves, the presence of wide QRS complexes, ST elevations in aVR and V1 leads; and signs of atrial fibrillation with slow ventricular rate ST segment elevations in V4R, V5R, and V6R on the right-sided ECG (Figure 1 and 2). The patient was monitored in the safety chamber, intravenous (IV) access was obtained, blood samples were drawn, and a normal saline infusion was administered along with the atropine 0,5 mcg IV push, up to a total dose of 3 mgs, followed by epinephrine infusion at a drip rate of 0.1 mcg/kg/min intravenously and transcutaneous pacing (Figure 3). The patient was referred to the catheter lab, where a total occlusion of right coronary artery was detected and intervened.

RESULT:In view of the fact that the underlying conditions and complications can be life-threatening, in the setting of bradyarrythmia, assessment and treatment is crucial. Treatment should be directed towards the underlying cause.