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June 17, 1983, Vol 249, No. 23 >
ARTICLE | June 17, 1983

Calcium Infusion for Reversal of Adverse Effects of Intravenous Verapamil FREE

D. Lynn Morris, MD; Nora Goldschlager, MD
[+] Author Affiliations

Reprint requests to Cardiology Service, San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110 (Dr Goldschlager).


JAMA. 1983;249(23):3212-3213. doi:10.1001/jama.1983.03330470052032
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References

VERAPAMIL hydrochloride has been shown to be useful in the treatment of symptomatic hypertrophic cardiomyopathy by decreasing left ventricular outflow obstruction, reducing left ventricular muscle mass, and increasing left ventricular diastolic compliance.1-4 Verapamil-related hemodynamic and electrophysiological complications in these cases have been documented in those with high pulmonary capillary wedge pressures in the presence of left ventricular outflow obstruction, evidence of congestive heart failure, substantive atrioventricular nodal dysfunction, and hypotension.3 Although clinical experience suggests that calcium may be effective in reversing the adverse effects of verapamil, such therapy has not been widely publicized.4-8 We report a case of a patient with hypotension and profound bradycardia caused by verapamil therapy for hypertrophic cardiomyopathy, which responded well to calcium chloride.

Report of a Case  A 56-year-old woman with echocardiographic diagnosis of hypertrophic cardiomyopathy, asymmetric septal hypertrophy, and systolic anterior motion of the mitral valve was admitted to San Francisco

REFERENCES

1 +
Rosing DR, Kent KM, Borer JS, et al:  Verapamil therapy: A new approach to the pharmacologic treatment of hypertrophic cardiomyopathy: I. Hemodynamic effects . Circulation 1979;;60:1201-1207.
2 +
Kaltenbach M, Hopf R, Kober G, et al:  Treatment of hypertrophic obstructive cardiomyopathy with verapamil . Br Heart J 1979;; 42:35-42.
3 +
Hauvath P, Mathey DG, Kremer P, et al:  Effect of verapamil on left ventricular isovolumic relaxation time and regional left ventricular filling in hypertrophic cardiomyopathy . Am J Cardiol 1980;;45:1258-1264.
4 +
Bonow RO, Rosing DR, Bacharach SL, et al:  Effects of verapamil on left ventricular systolic function and diastolic filling in patients with hypertrophic cardiomyopathy . Circulation 1981;; 64:787-796.
5 +
Epstein SE, Rosing DR:  Verapamil: Its potential for causing serious complications in patients with hypertrophic cardiomyopathy . Circulation 1981;;64:437-441.
6 +
Hariman RJ, Mangiardi LM, McAllister RG, et al:  Reversal of the cardiovascular effects of verapamil by calcium and sodium: Differences between electrophysiologic and hemodynamic responses . Circulation 1979;;59:797-804.
7 +
Hattori VT, Mandel WJ, Peter T:  Calcium for myocardial depression from verapamil . N Engl J Med 1982;;306:238.
8 +
Da Silva OA, De Melo RA, Filho JPJ:  Verapamil: Acute self poisoning . Clin Toxicol 1979;;14:361-367.
9 +
Moroni F, Mannaioni PF:  Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning . Clin Toxicol 1980;; 17:395-400.
10 +
Perkins CM:  Serious verapamil poisoning: Treatment with intravenous calcium gluconate . Br Med J 1978;;2:1127.
11 +
Rosing DR, Kent KM, Maron BJ, et al:  Verapamil therapy: A new approach to the pharmacologic treatment of hypertrophic cardiomyopathy: II. Effects on exercise capacity and symptomatic status . Circulation 1979;; 60:1208-1213.
12 +
Rosing DR, Condit JR, Maron BJ, et al:  Verapamil therapy: A new approach to the pharmacologic treatment of hypertrophic cardiomyopathy: III. Effects of long-term administration . Am J Cardiol 1981;;48:545-553.
13 +
Kieval J, Kirsten EB, Kessler KM, et al:  The effects of intravenous verapamil on hemodynamic status of patients with coronary artery disease receiving propranolol . Circulation 1982;; 65:653-659.
14 +
Packer M, Meller J, Medina N, et al:  Hemodynamic consequences of combined beta-adrenergic and slow calcium channel blockade in man . Circulation 1982;;65:660-668.
15 +
Gilman AG, Goodman LS, Gilman A: The Pharmacological Basis of Therapeutics . New York, Macmillan Publishing Co Inc, 1980;, p 1528.

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1 +
Rosing DR, Kent KM, Borer JS, et al:  Verapamil therapy: A new approach to the pharmacologic treatment of hypertrophic cardiomyopathy: I. Hemodynamic effects . Circulation 1979;;60:1201-1207.
2 +
Kaltenbach M, Hopf R, Kober G, et al:  Treatment of hypertrophic obstructive cardiomyopathy with verapamil . Br Heart J 1979;; 42:35-42.
3 +
Hauvath P, Mathey DG, Kremer P, et al:  Effect of verapamil on left ventricular isovolumic relaxation time and regional left ventricular filling in hypertrophic cardiomyopathy . Am J Cardiol 1980;;45:1258-1264.
4 +
Bonow RO, Rosing DR, Bacharach SL, et al:  Effects of verapamil on left ventricular systolic function and diastolic filling in patients with hypertrophic cardiomyopathy . Circulation 1981;; 64:787-796.
5 +
Epstein SE, Rosing DR:  Verapamil: Its potential for causing serious complications in patients with hypertrophic cardiomyopathy . Circulation 1981;;64:437-441.
6 +
Hariman RJ, Mangiardi LM, McAllister RG, et al:  Reversal of the cardiovascular effects of verapamil by calcium and sodium: Differences between electrophysiologic and hemodynamic responses . Circulation 1979;;59:797-804.
7 +
Hattori VT, Mandel WJ, Peter T:  Calcium for myocardial depression from verapamil . N Engl J Med 1982;;306:238.
8 +
Da Silva OA, De Melo RA, Filho JPJ:  Verapamil: Acute self poisoning . Clin Toxicol 1979;;14:361-367.
9 +
Moroni F, Mannaioni PF:  Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning . Clin Toxicol 1980;; 17:395-400.
10 +
Perkins CM:  Serious verapamil poisoning: Treatment with intravenous calcium gluconate . Br Med J 1978;;2:1127.
11 +
Rosing DR, Kent KM, Maron BJ, et al:  Verapamil therapy: A new approach to the pharmacologic treatment of hypertrophic cardiomyopathy: II. Effects on exercise capacity and symptomatic status . Circulation 1979;; 60:1208-1213.
12 +
Rosing DR, Condit JR, Maron BJ, et al:  Verapamil therapy: A new approach to the pharmacologic treatment of hypertrophic cardiomyopathy: III. Effects of long-term administration . Am J Cardiol 1981;;48:545-553.
13 +
Kieval J, Kirsten EB, Kessler KM, et al:  The effects of intravenous verapamil on hemodynamic status of patients with coronary artery disease receiving propranolol . Circulation 1982;; 65:653-659.
14 +
Packer M, Meller J, Medina N, et al:  Hemodynamic consequences of combined beta-adrenergic and slow calcium channel blockade in man . Circulation 1982;;65:660-668.
15 +
Gilman AG, Goodman LS, Gilman A: The Pharmacological Basis of Therapeutics . New York, Macmillan Publishing Co Inc, 1980;, p 1528.

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