Emerg Med J 20:98-100 doi:10.1136/emj.20.1.98
  • Case report

Haemodynamic and electrocardiographic consequences of severe nicorandil toxicity

  1. J P Greenwood1,
  2. I Malik2,
  3. P Jennings3,
  4. R N Stevenson3
  1. 1Academic Unit of Cardiovascular Medicine, Yorkshire Heart Centre, The General Infirmary, Leeds, UK
  2. 2Aintree University Hospital, Liverpool, UK
  3. 3Huddersfield Royal Infirmary, Huddersfield, UK
  1. Correspondence to:
 Dr J P Greenwood, Academic Unit of Cardiovascular Medicine, G Floor, Jubilee Wing, Yorkshire Heart Centre, The General Infirmary, Great George Street, Leeds LS1 3EX, UK;
  • Accepted 26 September 2002


A 35 year old woman was admitted to the emergency department two hours after ingesting 60×20 mg tablets of nicorandil, total 1.2 g. The dominant feature of icorandil toxicity was profound peripheral vasodilatation associated with coronary hypoperfusion. Despite widespread electrocardiographic signs of myocardial ischaemia, there was no evidence of myocardial damage and no serious cardiac arrhythmia. Volume loading and pressor support proved to be an effective treatment strategy.


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