Desipramine Conduction disorder mimicking myocardial infarction: case report

A 34-year-old woman taking desipramine 200mg for depression and propranolol 20mg tid for headaches suffered acute chest pain and hand numbness Pulse was 88/ mln, respiration 26/mln, BP 130/90mm Hg Auscultation revealed clear breath sounds , a regular cardiac rhythm with pronounced S2 and a possible opening snap, while an ECG showed sinus rhythm and left bundle-branch block On palpation the left antenor chest wall was tender The patient was anXIOUS , alert and talkative , Her onglnal therapy was replaced with oxygen , sublingual nitroglycerin [glyceryl tnnltrate] and IV morphine, to which the chest pain was unresponsive Anxiety was unrelieved by alprazolam 1 mg

On day 4, the left bundle-branch block resolved , and a recent transmural antenor myocardial Infarction was suspected . Card iac cathetensatlon was performed on day 8 because of chest pain , shortness of breath and anxiety The left mainstream artery was short but there was no occlusion The patient was diagnosed as having a conduct ion defect resulting from desipramine therapy , musculoskeletal chest pain , depression and anxiety , and was discharged on NSAIDs and phYSical therapy. SIX weeks later cardiac disease was not evident , although depression , anxiety and chroniC pain were The desipramine toxIcity may have been contributed to by the patient 's low bodywelght.

Desipramine toxIcity has produced 'a new electrocardiographic finding mimicking transmural myocardial infarction ',

Smith DB Tyznlk JW Postgraduat e MediCine 82 8688 15 Sep t 987

01577271 88 10116-0005 OS01.00/ 0 © ADIS Press REACTIONS ' 16 January 1988 5