A Case of Quinine-Induced High Degree Complete Heart Block in a Young Teenage Nigerian Female

Authors

  • Ajala AO Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
  • Oyan B Braithwaite Memorial Specialist Hospital, Port Harcourt, Rivers State, Nigeria
  • Dodiyi-Manuel S Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
  • Ejituwu J Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

DOI:

https://doi.org/10.60787/tnhj.v24i1.781

Keywords:

Quinine, atrioventricular block, toxicity, Nigeria

Abstract

Background: Third-degree atrioventricular block occurs when atrial and ventricular activity are autonomous of each other.

Method: This is a case of a 17-year-old lady presenting to the emergency room of the University of Port-Harcourt Teaching Hospital, Rivers State with sudden onset chest tightness and syncope immediately following a dose of intravenous Quinine administration for treatment of malaria at a peripheral clinic. Vital signs on arrival revealed marked bradycardia with a pulse rate of 17 beats per minute with a blood pressure reading of 110/40mmhg. An urgent electrocardiogram done showed a third-degree Atrioventricular (AV) Block with a slow ventricular escape rhythm and complete AV dissociation. She was a previously healthy young teenager with no history of effort intolerance or cardiac disease. There was also no history of cardiac disease or sudden cardiac death in any first degree relative. Drug-induced AV block was diagnosed based on history, clinical presentation, and investigations.

Result: AV block is not uncommon with drug use however, but third-degree AV block is rarely caused by drugs. Quinine use for treatment of malaria should be reviewed due to this life-threatening side-effect especially in a region where centers for temporary pacing are not widely available nor affordable in Nigeria.

Conclusion: Cardiovascular monitoring is essential if Quinine administration is indicated for prompt identification and treatment of cardiac electrical disturbances.

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Author Biography

Oyan B, Braithwaite Memorial Specialist Hospital, Port Harcourt, Rivers State, Nigeria

Depart of Medicine

References

Knabben V, Chhabra L, Slane M. Third-Degree Atrioventricular Block. 2023 Feb 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. PMID: 31424783: https://pubmed.ncbi.nlm.nih.gov/31424783.

Mangrum JM, DiMarco JP: The evaluation and management of bradycardia. N Engl J Med. 2000, 342:703-709. 10.1056/NEJM20000309342100

Hayes DL, Zipes DP: Cardiac pacemakers and cardioverter defibrillators. In: Braunwald E, Libby. P, Bonow RO, Mann DL, Zipes DP Heart disease, A Textbook of Cardiovascular Medicine, 8thPhiladelphia, PA (ed): WB Saunders Company, 2008832.

Ovsyshcher IE: Drug-Induced, Drug-Provoked and Drug-Associated Bradycardia. In: Cardiac Arrhythmias 2005. 2006, 569-574.

Zeltser D, Justo D, Halkin A, Rosso R, Ish-Shalom M, Hochenberg M et al. (2004: Drug-induced atrioventricular block: prognosis after. discontinuation of the culprit drug. J Am Coll Cardiol. 2004, 44:105-108. 10.1016/j.jacc.2004.03.057

Hauser TH, Pinto DS, Josephson ME, Zimethaum P: Safety and feasibility of a clinical pathway for the outpatient initiation of antiarrhythmic medications in patients with atrial fibrillation or atrial flutter. Am J Cardiol. 2003, 91:1437-1441. 10.1016/S0002-9149(03)00395-3

Israel CW, Ehrlich JR, Barold SS et al (2002) Treatment of tachyarrhythmias with pacing and antiarrhythmic drugs. In: Israel CW, Barold SS (eds) Advances in the treatment of atrial tachyarrhythmias: pacing, cardioversion, and defibrillation. Futura, Armonk, NY, pp 305–323

Esu E, Effa EE. Opie ON, Uwaoma A, Meremikwu MM: "Artemether for severe malaria". The. Cochrane database of systematic reviews. 2014, 1:83. 10.1002/14651858.CD010678.pub3

World Health Organization. (2015): Malaria [Internet]. [cited 2024 Mar 25]. Available from https://www.who.int/news-room/questions-and-answers/item/malaria?gad_source=1&gclid=Cj0KCQjwwYSwBhDcARIsAOyL0fho6vGXSw3xrgUimoJxQbXImctlXFlH2347642nUhEwmZZUuy7k9aMaAm_sEALw_wcB

Goldenberg AM, Wexler LF: Quinine Overdose: Review of toxicity and Treatment. Clin. Cardiol. 1988, 11:716-718. 10.1002/clc.496011101

Gachelin G, Garner P, Ferroni E, Tröhler U, Chalmers I: Evaluating Cinchona bark and quinine for treating and preventing malaria. J R Soc Med. 2017, 110:31-40

Taylor WRJ, White NJ: Antimalarial drug toxicity: a review. Drug Saf. 2004, 27:25-61. 10.2165/00002018-200427010-00003

J.K. Aronson: Quinine. Meyler's Side Effects of Drugs (Sixteenth Edition). Elsevier, 2016. 27:35. 10.1002/14651858.CD005044.pub3

Kerr F, Kenoyer G, Bilitch M: Quinidine overdose. Neurological and cardiovascular toxicity in a normal person. Br Heart J. 1971, 33:629-31. 10.1136%2Fhrt.33.4.629

Raine D, Lee A, Wiedmann R: Flash pulmonary oedema: a rare but serious side effect of quinine sulphate. Case Reports. 2012:0320114040. 10.1136/bcr.03.2011.4040

Krantz MJ, Dart RC, Mehler PS: Transient pulmonary infiltrates possibly induced by quinine sulfate. Pharmacotherapy. 2002, 22:775-8. 10.1592/phco.22.9.775.34070

Lim AKH, Ho L, Levidiotis V: Quinine-induced renal failure as a result of rhabdomyolysis, haemolytic uraemic syndrome and disseminated intravascular coagulation. Intern Med J. 2006, 36:465-467. 10.1111/j.1445-5994.2006. 01104.x

Achan J, Talisuna AO, Erhart A, Yeka A, Tibenderana JK, Baliraine FN, Rosenthal PJ, D'Alessandro U: Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria. Malar J. 2011, 24:144. 10.1186/1475-2875-10-144

Ovsyshcher IE, Barold SS (2004) Drug-induced bradycardia: to pace or not to pace? Pacing Clin Electrophysiol 27:1144–1147.

Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW et al.: adult advanced cardiovascular life support. 2010201012218, 3:729 - 767. Doi. 10.1161/CIRCULATIONAHA.110.970988

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Published

2024-03-29

How to Cite

Ajala, A., Oyan, B., Dodiyi-Manuel, S., & Ejituwu, J. (2024). A Case of Quinine-Induced High Degree Complete Heart Block in a Young Teenage Nigerian Female. The Nigerian Health Journal, 24(1), 1159–1165. https://doi.org/10.60787/tnhj.v24i1.781
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