Complete Heart Block Secondary to Section Concomitant Use of Metoprolol and Fluoxetine in a Case of Chronic Depression and Systemic Hypertension: A Case Report

Abstract

Bradyarrhythmia can be brought on by intrinsic or extrinsic causes that disrupt the cardiac conduction system, with iatrogenic drug usage being the most common extrinsic cause. Atrioventricular (AV) block is frequently brought on by beta-blockers, calcium channel blockers, anti-arrhythmics, and digoxin. The first course of treatment for heart block involves stopping the problematic medications. Psychotropic medications have the potential to cause cardiotoxic adverse effects that affect the heart. In a patient with a pre-existing cardiac disorder, psychotropic drugs can manifest with dangerous arrhythmias. It is yet unknown what intricate processes cause these effects. A variety of arrhythmias may be brought on by or made worse by many commonly used drugs. Hereby, the authors present a case report of 56-year-old hypertensive male, a known case of chronic depression with chest heaviness. The Electrocardiogram (ECG) revealed Complete Heart Block (CHB) with Right Bundle Branch Block (RBBB). The patient was on fluoxetine and beta-blockers for his mental illness and hypertension. Three days after withholding the drugs, the CHB resolved, and his baseline ECG remained as RBBB. The present case highlights the interaction of drugs leading to CHB in present patient. Therefore, the importance of a detailed drug history in such cases becomes imperative.

Keywords

• arrhythmias
• depressive disorder
• psychotropic drugs