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Case Reports
. 2024 Mar 16;16(3):e56288.
doi: 10.7759/cureus.56288. eCollection 2024 Mar.

Electrocardiographic Effects of Bupropion Toxicity Suggesting Dysfunction of the Gap Junction or Connexin 43

Patrick Bruss  1 , Ryan Hartle  1 , Jennifer Astacio  1 , Ammar F Chauhdri  2
Affiliations
Case Reports

Electrocardiographic Effects of Bupropion Toxicity Suggesting Dysfunction of the Gap Junction or Connexin 43

Patrick Bruss et al. Cureus. .

Abstract

This is a case of a 20-year-old pregnant female presenting EKG abnormalities associated with an overdose of bupropion. These ECG abnormalities are prolongation of the QRS, prolongation of the corrected QT interval (QTc), right axis deviation, and a terminal R wave. The propagation of electricity through the myocardium is dependent on many factors. It is dependent on the flow of sodium from the extracellular to intracellular space, flow of potassium from intracellular to extracellular space, and ultimately the propagation of the signal at the gap junction by Connexin 43 (Cx-43). We postulate that the ECG abnormalities in this case are secondary to bupropion's effect on the potassium rectifier channels (Kir) and or Cx-43 at the gap junction.

Keywords: bupropion; connexin-43; drug overdose and poisoning; ecg; gap junction toxicity.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Day 1, initial ECG, 18:08 hours, impending RAD, LPFB, no terminal R wave aVR.
RAD: right axis deviation; LPFB: left posterior fascicular block
Figure 2
Figure 2. Day 1, second ECG, 19:15 hours, RAD, LPFB, terminal R wave aVR.
Figure 3
Figure 3. Day 1, third ECG, 20:08 hours, worsening RAD, LPFB, terminal R wave aVR.
RAD: right axis deviation; LPFB: left posterior fascicular block
Figure 4
Figure 4. Day 4, last ECG during medical admission. Resolution of RAD and terminal R wave aVR.
RAD: right axis deviation
See this image and copyright information in PMC

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