DOI: 10.36347/sjmcr.2020.v08i10.003

Pages: 878-881

Introduction: Venlafaxine is a serotonin-norepinephrine reuptake inhibitor used as an antidepressant that causes usually a mild cardiotoxicity when ingested in overdose. We report a case of a patient who developed rhabdomyolysis and acute heart failure with LV thrombus attributed to venlafaxine overdose. After venlafaxine discontinuation, there was rapid improvement, with regression of the radiological abnormalities and normalization of the LVEF. Case report: A 21-year-old man was admitted to the intensive care for acute renal failure secondary to rhabdomyolysis (CPK > 140000 UI/L) 7 hours after the ingestion of an 11 g of VENLAFLAXINE, complicated by acute pulmonary edema with acute respiratory distress. The electrocardiogram showed T wave inversion in anterior leads, but normal QRS and QTc duration. Initial troponin T was 1005 µg/L BNP: 13 045 pg/ml .The patient developed severe acute pulmonary edema. The left ventricular shortening fraction was 56% on echocardiography with anteroseptal akinesis with a non-mobile round echodensity measuring 13 x 9 mm, consistent with an LV thrombus. The coronary arteries appear normal at coronary angiography. The patient was anuric and required continuous venovenous hemofiltration. Management consisted in noninvasive ventilation and dobutamine associated with intravenous isotonic saline, bicarbonate, and loop diuretics to control left ventricular dysfunction. Ventilator and cardiac support were maintained for 48 hours. Progressive improvement in respiratory failure was observed, and creatine kinase level decreased to 336 U/L on day 4, The patient was discharged from the intensive care unit on day 10, to Cardiology department with curative anticoagulation, Cardiac magnetic resonance imaging at Day 20 revealed edema of the anteroseptal walls on T2-weighted images and the T1 mapping, Furthermore, The anterospetal segment of the left ventricle was hypokinetic, and the echodensity structure was no longer visible in either a..........