SHM Converge Scientific Abstract ePoster Gallery-Sudden Cardiac Arrest in an Elderly Patient: An Unsuspecting Case of Haloperidol Induced Pulseless Electric Activity (Pea)

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This case report describes a 78-year-old man who suffered sudden cardiac arrest from pulseless electrical activity (PEA) after receiving haloperidol for severe agitation during hospitalization. He initially presented after a fall with left leg and hip pain, weakness, cough, mild rhabdomyolysis, exertional dyspnea, and COVID-19 infection, but no pneumonia or acute fracture. His admission EKG showed normal sinus rhythm without QT prolongation.<br /><br />During his stay, the patient became increasingly agitated and required antipsychotic treatment. Over several days he received haloperidol, including a 5 mg dose on hospital day five after becoming violently agitated. Telemetry later showed QT prolongation, increasing from 0.409 to 0.470 seconds, but no dangerous arrhythmia was recorded before arrest. A few hours after the last haloperidol dose, he experienced PEA arrest. Although resuscitated, he developed anoxic encephalopathy and was eventually transitioned to hospice care.<br /><br />The report emphasizes that haloperidol and other antipsychotics can prolong the QT interval and increase the risk of lethal arrhythmias, Torsades de Pointes, sudden cardiac death, and possibly PEA. It notes that antipsychotics are commonly used for delirium in hospitalized patients, especially older adults, despite the lack of FDA-approved medications for dementia-related psychosis. Prior studies have also linked antipsychotic use to sudden cardiac arrest, with a higher association in PEA cases than in VT/VF cases.<br /><br />The authors conclude that elderly patients receiving QT-prolonging medications require careful monitoring with serial EKGs and electrolyte checks, including sodium, potassium, and calcium. Haloperidol should be used cautiously or avoided when possible in this population.

Asset Subtitle

Saad Malik

Meta Tag

Author List Pooja Amirneni, Saad Malik, Satya H. Manda

Category Clinical Vignettes

Concept Haloperidol

Concept Antipsychotic-Induced QT Prolongation

Concept Pulseless Electrical Activity

Concept Antipsychotic Medication

Concept Elderly Patient

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/Denton

Presenting Author Saad Malik

Track Adult

Keywords

haloperidol

pulseless electrical activity

cardiac arrest

QT prolongation

antipsychotic

elderly patient

delirium

Torsades de Pointes

electrocardiogram monitoring

hospitalized patient

Haloperidol

Antipsychotic-Induced QT Prolongation

Pulseless Electrical Activity

Antipsychotic Medication

Elderly Patient