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Clinical Notes
November 1968

Phosphorus Poisoning Simulating Acute Myocardial Infarction

Arch Intern Med. 1968;122(5):430-434. doi:10.1001/archinte.1968.00040010430011

Elemental yellow phosphorus marketed in collapsible tubes as a rat poison and an insecticide, is an extremely toxic substance readily available in drug, grocery, and hardware stores as Electric Paste (net weight 62.5 gm, 2.5% [1.57 gm] elemental yellow phosphorus by weight). In a total of 115 patients attempting suicide with Electric Paste, Diaz-Rivera et al1,2 recorded 35 (30%) deaths. Acute cardiovascular collapse accounted for the majority of the deaths.

The heart is one of many organs affected by phosphorus, and several electrocardiographic abnormalities have been reported.1-4 However, changes diagnostic of or consistent with myocardial infarction have not been described. Recently we treated a patient with acute phosphorus poisoning whose electrocardiogram disclosed changes ordinarily interpreted as evidence of acute infarction of the anterolateral wall of the left ventricle. Rapid resolution and, ultimately, disappearance of the abnormal electrocardiographic pattern for myocardial infarct occurred within two weeks. At that time, a vectorcardiogram failed to demonstrate any deformation of the spatial QRS loop suggestive of myocardial infarction.