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Case Reports
. 2019 May 30;12(5):e229354.
doi: 10.1136/bcr-2019-229354.

Junctional bradycardia caused by ciguatera intoxication

Rajendra Raman  1   2 , Sarah Coppes  2   3 , Tessa Hellingman  2   4 , Casper Laclé  2
Affiliations
Case Reports

Junctional bradycardia caused by ciguatera intoxication

Rajendra Raman et al. BMJ Case Rep. .

Abstract

Ciguatera is a common but underreported tropical disease caused by the consumption of coral reef fish contaminated by ciguatoxins. Gastrointestinal and neurological symptoms predominate, but may be accompanied by cardiovascular features such as hypotension and sinus bradycardia. Here, we report an unusual case of junctional bradycardia caused by ciguatera in the Caribbean; to our knowledge, the first such report from the region. An increase in global sea temperatures is predicted to lead to the spread of ciguatera beyond traditional endemic areas, and the globalisation of trade in coral reef fish has resulted in sporadic cases occurring in developed countries far away from endemic areas. This case serves as a reminder to consider environmental intoxications such as ciguatera within the differential diagnosis of bradycardias.

Keywords: arrhythmias; poisoning.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
ECG at presentation showing junctional bradycardia of 45/min with sinus node arrest and retrograde atrial depolarisation.
Figure 2
Figure 2
ECG at follow-up, showing normal sinus rhythm at 60/min.
See this image and copyright information in PMC

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