Confusion and Lightheadedness Related to Calcium Channel Blocker Toxicity

Abstract

Calcium channel blockers are commonly used drugs to control blood pressure and heart rate. These drugs can significantly depress cardiac inotropy and chronotropy at high doses, with adverse effects. We present the case of a woman, recently started on diltiazem for hypertension, who presented with severe hypotension and bradycardia. Electrocardiogram at admission, revealed a junctional rhythm. She was initially resuscitated with intravenous fluids and atropine boluses without any response. Septic workup, cardiac biomarkers, thyroid stimulating hormone and cortisol levels were normal. Hemodynamics gradually improved on glucagon and dopamine drip. She reverted back to normal sinus rhythm in about six hours. This case illustrates the importance of medication reconciliation in patients.