Drug Interaction of Amiodarone, Flecainide, Metoprolol and Diltiazem leading to Heart Block.

Amiodarone, flecainide, metoprolol and diltiazem individually are known to cause heart blocks due to their cardiac depressant property but the current case report is worth reporting because it resulted because of drug interaction of multiple drugs due to possible medication error.

Cardiac complication secondary to jugular catheter insertion in a renal failure patient

Central venous catheterisation is a common procedure performed for emergency dialysis. It is usually carried out without any cardiac monitoring. Cardiac arrhythmias with associated conduction blocks are rare complications. The underlying pathogenesis is trauma to the endocardium by the guide wire or catheter. It occurs more frequently in patients with acute renal failure and azotaemia than patients with established end stage renal disease. Disturbances in acid base balance and electrolyte abnormalities are contributing factors. Fortunately, most are benign but occasionally can lead to potentially fatal arrhythmias. We report a case of a 46-year-old lady with end stage renal failure secondary to diabetes mellitus who developed runs of transient ventricular ectopics and right bundle branch block during internal jugular catheterisation. This spontaneously resolved 12 hours later.