Cardiovascular complications of poisoning

Many poisons affect the heart or blood vessels or their autonomic control; these direct or indirect effects result in cardiovascular complications that contribute substantially to morbidity and mortality in poisoned patients. Direct cardiotoxic effects can alter heart rate, conduction or rhythm, resulting in sinus bradycardia (e.g. β-adrenoceptor blockers, calcium channel blockers) or tachycardia (e.g. sympathomimetic agents such as cocaine) or dysrhythmias such as torsade de pointes, ventricular tachycardia or ventricular fibrillation. Hypertension can be caused by cardiac stimulation or vasoconstriction, and hypotension by hypovolaemia, vasoplegia or poor cardiac output. The cardiovascular impact of poisoning can be exacerbated by pre-existing co-morbidities such as heart, respiratory or liver disease. Here we describe a pragmatic approach to the identification, monitoring and treatment of common cardiovascular complications of poisoning.