Mobitz type II atrioventricular block associated with tizanidine usein a patient with left ventricular hypertrophy: a case report
DOI:
https://doi.org/10.37711/Keywords:
atrioventricular block, adverse drug reaction, left ventricular hypertrophy, electrophysiology, sinus arrhythmiaAbstract
A case is presented involving a 52-year-old woman with no significant medical history who attended a routine check-up. An initial electrocardiogram revealed left ventricular hypertrophy, prompting a 24-hour Holter monitor. This test showed the presence of supraventricular extrasystoles and episodes of second-degree atrioventricular (AV) block, type Mobitz II, which is unusual in an asymptomatic patient without structural heart disease. The patient was being treated with tizanidine for muscle pain, raising suspicion of a potential association between the medication and the transient AV block. Following the discontinuation of tizanidine, subsequent Holter monitoring demonstrated normalization of AV conduction. The patient remained stable and asymptomatic. This case highlights the importance of considering medication side effects, as second-degree AV block type Mobitz II can progress to more severe conditions.
Downloads
References
1. Serge Barold S, Hayes DL. Second-degree atrioventricular block: a reappraisal. Mayo Clin Proc. [Internet]. 2001 [Consultado el 2 de noviembre de 2024];76(1):44-57. doi: 10.4065/76.1.44
2. El-Sherif N, Scherlag BJ, Lazzara R. Pathophysiology of second degree atrioventricular block: a unifed hypothesis. Am J Cardiol. [Internet]. 1975 [Consultado el 2 de noviembre de 2024];35(3):421-34. doi: 10.1016/0002-9149(75)90036-3
3. Cortes J, Hall B, Redden D. Profound symptomatic bradycardia requiring transvenous pacing after a single dose of tizanidine. J Emerg Med. [Internet]. 2015 [Consultado el 2 de noviembre de 2024];48(4):458-60. doi: 10.1016/j.jemermed.2014.10.005
4. Publow SW, Branam DL. Hypotension and bradycardia associated with concomitant tizanidine and lisinopril therapy. Am J Health Syst Pharm. [Internet]. 1 de octubre de 2010 [Consultado el 2 de noviembre de 2024];67(19):1606-10. doi: 10.2146/ajhp090657
5. Killam-Worrall L, Brand R, Castro JR, Patel DS, Huynh K, Lindley B, et al. Baclofen and Tizanidine Adverse Effects Observed Among Community-Dwelling Adults Above the Age of 50 Years: A Systematic Review. Ann Pharmacother. [Internet]. Mayo de 2024 [Consultado el 2 de noviembre de 2024];58(5):523-32. doi: 10.1177/10600280231193080
6. Cortes J, Hall B, Redden D. Profound symptomatic bradycardia requiring transvenous pacing after a single dose of tizanidine. J Emerg Med. [Internet]. 2015 [Consultado el 2 de noviembre de 2024];48(4):458-60. doi: 10.1016/j.jemermed.2014.10.005
7. Sandau KE, Funk M, Auerbach A, Barsness GW, Blum K, Cvach M, et al. Update to Practice Standards for Electrocardiographic
Monitoring in Hospital Settings: A Scientifc Statement Fromthe American Heart Association. Circulation [Internet]. 2017 [Consultado el 2 de noviembre de 2024];136(19):E273-344. https://doi.org/10.1161/CIR.0000000000000527
8. Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. [Internet]. 2018 [Consultado
el 2 de noviembre de 2024];16(9):e128-226. doi: 10.1016/j.hrthm.2018.10.037
9. Ragupathi L, Johnson D, Greenspon A, Frisch D, Ho RT, Pavri BB. Clinical and electrophysiological characteristics of patients with paroxysmal intra-His block with narrow QRS complexes. Heart Rhythm. [Internet]. 2018 [Consultado el 2 de noviembre de 2024];15(9):1372-7. doi: 10.1016/j.hrthm.2018.04.013
10. Sandau KE, Funk M, Auerbach A, Barsness GW, Blum K, Cvach M, et al. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientifc Statement From the American Heart Association. Circulation [Internet]. 2017 [Consultado el 2 de noviembre de 2024];136(19):E273-344. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28974521/
11. Bhatt AB, Foster E, Kuehl K, Alpert J, Brabeck S, Crumb S, et al. Congenital heart disease in the older adult: a scientifc statement from the American Heart Association. Circulation [Internet]. 2015 [Consultado el 2 de noviembre de 2024];131(21):1884-931. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25896865/
12. Barra SNC, Providância R, Paiva L, Nascimento J, Marques AL. A review on advanced atrioventricular block in young or middle-aged adults. Pacing Clin Electrophysiol [Internet]. 2012 [Consultado de 2 de noviembre de 2024];35(11):1395-405. Disponible en: https://pubmed.ncbi.nlm.nih.gov/22897386/
13. El Sherif N, Scherlag BJ, Lazzara R. Second-degree atrioventricular block in the His-Purkinje system following acute myocardial infarction. Clinical observations on its evolution. Chest [Internet]. 1977 [Consultado el 2 de noviembre de 2024];71(5):615-23. Disponible en: https://pubmed.ncbi.nlm.nih.gov/856559/
14. Li X, Jin Y. Irreversible profound symptomatic bradycardia requiring pacemaker after tizanidine/loxoprofen combination therapy: a case report. J Int Med Res [Internet]. 2018 [Consultado el 2 de noviembre de 2024];46(6):2466-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29587554/
15. Cortes J, Hall B, Redden D. Profound symptomatic bradycardia requiring transvenous pacing after a single dose of tizanidine. J Emerg Med. [Internet]. 2015 [Consultado el 2 de noviembre del 2024];48(4):458-60. Disponible en: https://pubmed.ncbi. nlm.nih.gov/25456780/
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Jorge Andrés Hernández Navas, Juan Sebastián Therán León, Luis Andrés Dulcey Sarmiento, Jaime Alberto Gómez Ayala, Jerson Quitian Moreno, Valentina Ochoa Castellanos
This work is licensed under a Creative Commons Attribution 4.0 International License.
