Skip to main content

Advertisement

Log in

A Prospective Study on Electrocardiographic Findings of Patients with Organophosphorus Poisoning

  • Published:
Cardiovascular Toxicology Aims and scope Submit manuscript

Abstract

Organophosphate (OP) compounds are widely used in different applications including agriculture. The widespread use of OP insecticides, however, brings high risks of severe health problems. Besides occupational poisoning in industrial production and agricultural application, instances of acute organophosphate poisoning (OPP) also include suicide, homicide, and accidental overdose. Cardiovascular manifestations frequently accompany exposure to these organophosphorus compounds, but their exact nature is not fully elucidated. In this study, we evaluated 20 patients who presented to our emergency department with organophosphorus (OP) poisoning and discussed their associated electrocardiographic (ECG) abnormalities. Over 3 months, 20 patients with OP poisoning were included in this prospective study. ECG analysis included the rate, ST-T abnormalities, conduction defects, and measurement of PR and “QTc” intervals. Our results show that 12 patients were having prolonged QTc interval i.e., >0.43 s. Eight patients were having mild elevated ST segment and low-amplitude “T” waves. Most of the patients have shown increased heart rate, where as some has shown decreased value. From this study, we conclude that acute organophosphorus poisoning is associated with ventricular arrhythmias, tachycardia and bradycardia, and attributes mild myocardial ischemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gagandeep, S., & Dheeraj, K. (2009). Neurology of acute organophosphate poisoning. Neurology India, 57, 119–125.

    Article  Google Scholar 

  2. Vijayakumar, S., Fareedullah, M., Venkateswarlu, B., Sudhakar, Y., & Ashok kumar, E. (2010). Current review on organophosphorus poisoning. Archives of Applied Science Research., 2(4), 199–215.

    Google Scholar 

  3. Comroe, J. H., Todd, J., Gammon, G. D., Leopold, I. H., Koelle, G. B., & Bodansky, O. (1946). The effect of di-isopropyl-fluorphosphate (DFP) upon patients with myasthenia gravis. American Journal of the Medical Sciences, 212, 641–651.

    Article  PubMed  CAS  Google Scholar 

  4. Grob, D., & Harvey, A. M. (1949). Observations on the effects of tetraethyl pyrophosphate (TEPP) in man and on its use in treatment of myasthenia gravis. Bull Johns Hopkins Hospital, 84, 533–567.

    Google Scholar 

  5. Rider, J. A., Schulman, S., Richtern, R. B., Moeller, H. D., & Du Bois, K. P. (1951). Treatment of myasthenia gravis with octainethyl pyrophosphoramide. JAMA, 145, 967–972.

    CAS  Google Scholar 

  6. Khurram, S. R., Owais, F. M., Ahmad, B., Qurashi, F. S., & Shaheen, M. (2008). Organophosphorus compound poisoning; Epidemiology and management. Professional Medical Journal, 15(4), 518–523.

    Google Scholar 

  7. Ludomirsky, A., Klein, H. O., Sarelli, P., Becker, B., Hoffman, S., & Taitelman, U. (1982). Q-T prolongation and polymorphous (“Torsade de pointes”) Ventricular arrhythmias associated with OP insecticide poisoning. The American Journal of Cardiology, 49, 1654–1658.

    Article  PubMed  CAS  Google Scholar 

  8. Povoa, R., Cardoso, S. H., & Luna-Filho, B. (1997). Organophosphate poisoning and myocardial necrosis. Arquivos Brasileiros de Cardiologia, 68, 377–380.

    PubMed  CAS  Google Scholar 

  9. Saadeh, A. M., Farsakh, N. A., & Al-Ali, M. K. (1997). Cardiac manifestations of acute carbamate and organophosphate poisoning. Heart, 77, 461–464.

    PubMed  CAS  Google Scholar 

  10. Juliana, M. T., Nathan, D. M., Diana, A. M., Francisco, T. R., & Ana, L. K. (2009). Cardio-respiratory function and oxidative stress biomarkers in Nile-tilapia exposed to the organophosphate insecticide trichlorfon. Ecotoxichology and Environmental Safety, 72, 1413–1424.

    Article  Google Scholar 

  11. Yusuf, Y., Yucel, Y., Hayrettin, S., Polat, D., Seda, O., & Okhan, A. (2009). Electrocardiographic findings of acute organophosphate poisoning. Journal of Emergency Medicine, 36, 39–42.

    Article  Google Scholar 

  12. Kiss, Z., & Fazekas, T. (1979). Arrhythmias in organophosphate poisonings. Acta Cardiologica, 34, 323–330.

    PubMed  CAS  Google Scholar 

  13. Cherian, M. A., Roshini, C., Peter, J. V., & Cherian, A. M. (2005). Oximes in organophosphorus poisoning. Indian Journal of Critical Care Medicine, 9, 155–163.

    Article  Google Scholar 

  14. Schwart, P. F., & Priori, S. G. (2004). Long QT syndrome: genotype-phenotype correlations. In D. P. Zipes & J. Jalife (Eds.), Cardiac electrophysiology from cell to bedside (4th ed., pp. 651–659). Philadelphia: Saunders.

    Google Scholar 

  15. Ford, G. A., Wood, S. M., & Daly, A. K. (2003). CYP2D6 and CYP2C19 genotypes of patients with terodiline cardiotoicity identified through the yellow card system. British Journal of Clinical Pharmacology, 50, 77–80.

    Article  Google Scholar 

  16. Priori, S. G., Schwartz, P. J., Napolitano, C., Bloise, R., Ronchetti, E., Grillo, M., et al. (2003). Risk stratification in the long-QT syndrome. New England Journal of Medicine, 348, 1866–1874.

    Article  PubMed  Google Scholar 

  17. Luzhnikov, E. A., Savina, A. S., & Shepelev, V. M. (1975). Pathogenesis of disorders of cardiac rhythm and conductivity in acute organophosphate insecticide poisoning. Kardiologia (U.S.S.R.), 15, 126–129.

    CAS  Google Scholar 

  18. Ludomirsky, A., Klein, H. O., Sarelli, P., Becker, B., Hoffman, S., Taitelman, U., et al. (1982). QT prolongation and polymorphous (torsade de pointes) ventricular arrhythmias associated with organophosphorus insecticide poisoning. American Journal of Cardiology, 49, 1654–1658.

    Article  PubMed  CAS  Google Scholar 

  19. Kumiko, T., Yoshiko, A., & Miwako, K. (2006). Long QT and ST-T change associated with organophosphate exposure by aerial spray. Environmental Toxicology and Pharmacology, 22, 40–45.

    Article  Google Scholar 

  20. Thevenin, J., Da Costa, A., Roche, F., Romeyer, C., Messier, M., & Isaaz, K. (2003). Flecainide induced ventricular tachycardia (torsades de pointes). Pacing and Clinical Electrophysiology, 26, 1907–1908.

    Article  PubMed  Google Scholar 

  21. Abraham, S., Oz, N., Sahar, R., & Kadar, T. (2001). QTc prolongation and cardiac lesions following acute organophosphate poisoning in rats. Proceedings of the Western Pharmacology Society, 44, 185–186.

    PubMed  CAS  Google Scholar 

  22. Lovejoy, F. H., & Linden, C. H. (1991). Acute poison and drug overdosage. In: Harrison’s principles of internal medicine (12th ed., p. 2178) New York: McGraw-Hill.

  23. Hayes, M. M., Van der Westhuizen, N. G., & Gelfand, M. (1978). Organophosphate poisoning in Rhodesia. A study of the clinical features and management of 105 patients. South African Medical Journal, 54, 230–234.

    PubMed  CAS  Google Scholar 

  24. Bardin, P. G., Van Eeden, S. F., & Joubert, J. R. (1987). Intensive care management of acute organophosphate poisoning. A 7-year experience in the Western Cape. South African Medical, 72, 593–597.

    CAS  Google Scholar 

  25. Namba, T., Nolte, C. T., Jackrel, J., & Grob, D. (1971). Poisoning due to organophosphate insecticides. Acute and chronic manifestations. American Journal of Medicine, 50, 475–492.

    Article  PubMed  CAS  Google Scholar 

  26. Reigart, J. R., & Roberts, J. R. R. (1999). Recognition and management of pesticide poisonings (5th ed.). Washington: US Environmental Protection Agency.

    Google Scholar 

Download references

Acknowledgments

Authors are thankful to Mr. R. Sunil and Mr. G. Prashanth, Cardio technicians of our hospital for their valuable support in spite of their busy schedule.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Subash Vijayakumar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vijayakumar, S., Fareedullah, M., Ashok Kumar, E. et al. A Prospective Study on Electrocardiographic Findings of Patients with Organophosphorus Poisoning. Cardiovasc Toxicol 11, 113–117 (2011). https://doi.org/10.1007/s12012-011-9104-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12012-011-9104-4

Keywords

Navigation