Death due to fulminant neuroleptic malignant syndrome induced by low doses of haloperidol: a rare case.

The paper reports on a rare case of fulminant neuroleptic malignant syndrome (NMS) with several risk factors, typical manifestation and rapid death induced by low doses of haloperidol. The pathological findings, pathogenesis, clinical manifestations, diagnostic criteria, risk factors and other features of NMS are discussed. The importance of forensic pathologists being aware of the possibility of NMS as the cause of death in people taking antipsychotic drugs is stressed.

Psilocybin mushroom (Psilocybe semilanceata) intoxication with myocardial infarction.

CASE REPORT: Intentional intoxication with natural hallucinogenic substances such as hallucinogenic mushrooms continues to be a major problem in the US and Europe, particularly in the harbor complex of northwest Poland (Pomerania). A case is described of Psilocybe intoxication in an 18-year-old man resulting in Wolff-Parkinson-White syndrome, arrhythmia, and myocardial infarction. The indole concentrations of hallucinogenic mushrooms may predict the risk for adverse central nervous system and cardiac toxicity.

Adenosine-induced atrial arrhythmia: a prospective analysis.

BACKGROUND: Adenosine is considered safe and effective for paroxysmal supraventricular tachycardia (PSVT), but anecdotal experience suggests that adenosine can precipitate atrial arrhythmias. OBJECTIVES: To determine the frequency and mechanisms of adenosine-induced atrial arrhythmias. SETTING: Clinical electrophysiology laboratory at a university medical center. DESIGN: Prospective observational study. PATIENTS: 200 consecutive patients with PSVT undergoing an electrophysiology procedure. INTERVENTION: During PSVT, 12 mg of adenosine was administered centrally through the femoral vein. MEASUREMENTS: Frequency of adenosine-induced atrial fibrillation. RESULTS: Paroxysmal supraventricular tachycardia terminated after adenosine administration in 198 patients (99% [95% CI, 96% to 100%]). Adenosine led to atrial fibrillation (n = 22) or atrial fibrillation and atrial flutter (n = 2) in 24 patients (12% [CI, 7.5% to 16.5%]). An atrial premature complex occurred in all 24 patients who developed atrial fibrillation, atrial flutter, or both and in 102 of the 176 patients (58%) who did not (P < 0.001). The mean (+/-SD) time from the preceding atrial complex to the atrial premature complex was shorter when an atrial arrhythmia occurred, and the mean ratio of this interval to the preceding atrial cycle length was also lower when atrial fibrillation developed (0.37 +/- 0.16 compared with 0.49 +/- 0.16; P = 0.002). CONCLUSIONS: The incidence of atrial fibrillation induced by 12 mg of adenosine administered through the femoral vein was 12%. Fibrillation seems to be associated with a "long-short" atrial sequence. If the mechanism of PSVT is unknown and the Wolff-Parkinson-White syndrome is possible, administration of adenosine should be limited to medical facilities that have emergency resuscitation equipment.

[Studies on cardio-circulatory effects of carpipramine. Results of a double-blind study (author's transl)]. / Untersuchungen zur Herz-Kreislauf-Wirkung von Carpipramin. Ergebnisse einer Doppelblindstudie

For eight weeks 30 psychotic patients with a healthy cardiovascular system received 3 X 50 mg 1-[3-(10,11-dihydro=5H-dibenz[b,f]-azepin-5-yl]-propyl]-4-piperidiono-piperdine-4-carboxamide dihydrochloride-monohydrate (carpipramine) per day with a placebo phase of three weeks either previous to the medication of succeeding it. In addition there was a group of similar patients without any medication. From this study it was concluded that carpipramide has no depressive effect on the cardiovascular system. The differences in blood pressure and heart rate after the change from medication to placebo indicate a certain vegetative lability in this phase. In the ECG, no irregularities of the atrioventricular and intraventricular conduction and its repolarisation in form of a lengthening were observed; only the WPW-syndrome noticed with one patient might be related to the medication since it occurred at the end of the three weeks during which carpipramine had been administered.