Unusual aetiology of a type 2 myocardial infarction: a case-based review

Organophosphate pesticide (OP) poisoning is quite common and can cause cardiovascular complications and even direct myocardial injury. However, no guideline has included an acute poisoning as a potential cause for a type 2 myocardial infarction (MI) so far. Here we present a case of a 61-year-old woman brought by ambulance to emergency department one hour after accidental ingestion of an unknown quantity of a solution she used against flea infestation. The patient presented with dizziness, myosis, excessive sweating, hypersalivation, sphincteric incontinence, muscle fasciculation, tremor of the extremities, pale skin, alcoholic and pesticide breath odour. Even though we had no guidelines to fall back on, we successfully treated the patient with low-molecular-weight heparin, antiplatelets, statin, diltiazem, antidote therapy, and supportive care. Physicians should be aware that OP poisoning can induce type 2 MI as a complication within a few hours since exposure, and emergency management should always include close cardiac monitoring.

Case Series: Organophosphate Contamination of Camel’s Mammary Glands Affects Human Health

In this case series, we present 2 cases of previously healthy farmers, who presented with symptoms of a cholinergic crisis that developed several hours after ingestion of camel milk. The initial case was treated with supportive medical care without using antidote as no history of direct exposure to pesticides was available.The second case presented with symptoms of cholinergic crisis that developed several hours after the ingestion of camel milk. Clinical features included slurred speech, headache, vomiting, diarrhea, frequent ­micturition, muscle fasciculation, chest discomfort, and atrial fibrillation. The patient developed bradycardia that responded to intravenous atropine. Routine investigations were unremarkable, but acetylcholinesterase and pseudocholinesterase levels were both low. The patient was managed with intravenous fluids, analgesia, atropine, and pralidoxime, which were administered when he developed respiratory symptoms secondary to excessive secretions. The following day, the patient was asymptomatic and discharged. On the medical history, the patient denied any other ingestion including food and drink or potential organophosphate exposure on the day of symptom onset. Application of organophosphate pesticides to the mammary glands of camels has been used for many decades against <i>Sarcoptes scabei cameli</i>, a mite that causes a dermal infestation in camels similar to human scabies infections.