Acta Scientific Women's Health (ASWH)(ISSN: 2582-3205)

Case Report Volume 4 Issue 4

Complete Heart Block Leading to Acute Delirium, A Case Report

Osama Osman*, Connor Clarkston, Julie Gammack, Lina Toledo-Franco, A Hussein, I Atallah, Stephanie Chen and Ali Khan

Department of Internal Medicine/Geriatric Medicine, SLU, USA

*Corresponding Author: Osama Osman, Department of Internal Medicine/Geriatric Medicine, SLU, USA.

Received: March 17, 2022; Published: March 25, 2022

Abstract

Delirium is defined as an acute disorder of attention and cognition. It is common among older patients [1]. Studies have shown that 25-30% of medical inpatients develop delirium; with infections and heart failure the most common reported etiologies [2] while metabolic etiologies account for 80-90% of cases. Delirium occurs in 22–89% of patients with dementia in hospitals and nursing homes [3]. It also increases the cost of hospitalization by ~$ 16,000-64,000 per patient [4]. The causes of delirium are divided into precipitating factors and vulnerability factors [5]. Vulnerability factors include male gender, age ≥ 65 years, educational background, various comorbidities (i.e., dementia, chronic kidney disease, end-stage liver disease, terminal illness), baseline functional status (i.e., immobility, visual impairment, hearing impairment), baseline medication usage (i.e., polypharmacy, psychoactive medication, drug use, and substance withdrawal), malnutrition, dehydration, depression, and circadian rhythm disruption [5]. Precipitating factors include severe illness, infection, sepsis, inadequate pain control, trauma, and hypo- or hyperthermia. Among central nervous system illnesses, examples include intracerebral hemorrhage, cerebrovascular accident, meningitis/encephalitis, nonconvulsive status epilepticus, cerebral edema, tumor, and hydrocephalus. Examples of metabolic disorders that can precipitate delirium include thiamine deficiency, renal failure, liver failure, electrolyte imbalance, hypo- or hyperglycemia, thyroid dysfunction, glucocorticoid therapy hypophysis dysfunction, and porphyria. Cardiorespiratory factors include acute coronary disease, congestive cardiac failure, hypoxemia, hypercarbia, shock, and hypertensive encephalopathy. Mobility restriction is another precipitating factor including the use of physical restraints, bladder catheters, intubation, and assisted ventilation. In addition, other precipitating factors also include malignant hyperthermia, serotonin syndrome, malignant catatonia, paraneoplastic syndrome, >3 medications recently added, anti-NMDA(N-methyl-D-aspartate) encephalitis, and any iatrogenic causes. Infection is the most reported precipitating factor, while dementia is most consistently mentioned among the vulnerability factors [6,7].

However, delirium due to a complete heart block in an elderly patient presents an unusual cause. To our knowledge, only one case reported by Fearon., et al. in 1992 of an elderly patient who developed delirium due to complete heart block. Here we present another case of delirium in a ninety-year-old female with complete heart block.

Keywords:Delirium; Geriatric; Old Patient; Heart Block; Electrocardiogram

References

  1. Oh ES., et al. “Delirium in Older Persons: Advances in Diagnosis and Treatment”. JAMA 12 (2017): 1161-1174.
  2. Fearon MP and LaPalio L. “Complete heart block presenting as intermittent delirium: case report and review of the literature on cardiac disease in the elderly”. Journal of the American Geriatrics Society 5 (1992): 507-509.
  3. Fick DM., et al. “Delirium superimposed on dementia: A systematic review”. Journal of the American Geriatrics Society 50 (2002): 1723-1732.
  4. Leslie DL., et al. “One-year health care costs associated with delirium in the elderly population”. Archives of Internal Medicine 168 (2008): 27-32.
  5. Inouye SK. “Delirium in hospitalized older patients: Recognition and risk factors”. Journal of Geriatric Psychiatry and Neurology 11 (1998): 118-158.
  6. Inouye SK., et al. “Delirium in elderly people”. Lancet 383 (2014): 911-922.
  7. Elie M., et al. “Delirium risk factors in elderly hospitalized patients”. Journal of General Internal Medicine 13 (1998): 204-212.
  8. Cole MG. “Delirium in Elderly Patients”. Focus2 (2005): 320-332.
  9. Fisher AA., et al. “Acute delirium induced by metoprolol”. Cardiovascular Drugs Therapy2 (2002): 161-165.
  10. van der Vleuten PA., et al. “Delirant beeld, toegeschreven aan het gebruik van metoprolol [Delirium attributed to the use of metoprolol]”. Ned Tijdschr Geneeskd39 (2005): 2183-2186.

Citation

Citation: Osama Osman., et al. “Complete Heart Block Leading to Acute Delirium, A Case Report". Acta Scientific Women's Health 4.4 (2022): 09-11.

Copyright

Copyright: © 2022 Osama Osman., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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