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January 30, 1978

Extreme Sinus Bradycardia Following Routine Venipuncture

Author Affiliations

Shaare Zedek Hospital Hebrew University-Hadassah Medical School Jerusalem

JAMA. 1978;239(5):403-404. doi:10.1001/jama.1978.03280320019009

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To the Editor.—  Tizes recently described (236:1846-1847, 1976) "cardiac arrest" in a patient following venipuncture. The arrest was assumed by the absence of heart sounds and pulses, cessation of breathing, and other symptoms, but without ECG recording; the patient recovered after cardiopulmonary resuscitation. We recently had a very similar case, which supplies ECG evidence of what may happen during a routine venipuncture.

Report of a Case.—  A 54-year-old man who five years earlier had a coronary bypass operation was admitted with chest pain to our Coronary Care Unit. Here a routine venipuncture was done while his ECG was constantly monitored. Immediately after the needle puncture, the patient complained of weakness and within two seconds lost consciousness. The ECG showed extremely slow sinus rhythm with possible sinoatrial block, prolonged sinus pauses, and nodal escape rhythm (Figure 1). Atropine, 1.0 mg, was immediately administered through an open intravenous (IV) route in his