Collapse in the elderly: rivastigmine-induced heart block and a literature review of the pharmacology of acetylcholinesterase inhibitors used in Alzheimer's disease

BMJ Case Rep. 2018 Apr 17:2018:bcr2018224597. doi: 10.1136/bcr-2018-224597.

Abstract

Falls resulting in neck of femur fractures are common in the elderly. Often multiple comorbidities can make management and diagnosis of such a polyfactorial condition difficult, particularly with Alzheimer's dementia (AD). Indeed, poorly managed AD may contribute to falls. We present our management of an 87-year-old woman, on rivastigmine for AD, who presented with a collapse episode-attributed to rivastigmine-resulting in a neck of femur fracture. Furthermore, we perform a literature review of the pharmacology of acetylcholinesterase inhibitors and how their use in AD may contribute to bradyarrhythmias.

Keywords: arrhythmias; dementia, alzheimer’s type; perioperative care; safety; unwanted effects / adverse reactions.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Accidental Falls
  • Aged, 80 and over
  • Alzheimer Disease / drug therapy*
  • Bradycardia / chemically induced*
  • Cholinesterase Inhibitors / administration & dosage
  • Cholinesterase Inhibitors / adverse effects
  • Cholinesterase Inhibitors / pharmacology*
  • Female
  • Femoral Neck Fractures / surgery*
  • Heart Block / chemically induced*
  • Hemiarthroplasty
  • Humans
  • Pacemaker, Artificial
  • Rivastigmine / administration & dosage
  • Rivastigmine / adverse effects*
  • Rivastigmine / pharmacology*
  • Treatment Outcome

Substances

  • Cholinesterase Inhibitors
  • Rivastigmine