Introduction: Viper insecticide is a commonly used product in gardening. Its active ingredient Cypermethrin Pyrethroid has been known to cause toxicity through ingestion, inhalation or skin contact. The symptoms of toxicity include neurotoxicity, cardiotoxicity, and gastrointestinal symptoms. In this case we will discuss a case of symptomatic bradycardia as a result of cypermethrin toxicity. This case highlights the importance of environmental exposure.

Case: 69-year-old male with NASH cirrhosis, HLD, GERD, and history of gout presented with chief complaints of Dizziness and bradycardia. Patient reported over the past few days prior to presentation he has been having episodes of near-syncope during which his HR has been ranging between 30s to 60s. EKG showed some sinus bradycardia and infrequent PACs and PVCs. Patient also reported intermittent, dull in quality Chest pain, located in the substernal/epigastric area, radiating to the left arm which lasted a few seconds and was not associated with shortness of breath. The episodes were associated with nausea but no vomiting. At baseline, patient reports of being active, walks daily and intentional weight loss of 40lb over the last one year. Review of medications did not show any offending agent that could possibly cause bradycardia or dizziness. The patient denied using any supplements. Upon reviewing any possible chemical exposure, the patient stated he uses Viper insecticide (active ingredient Cypermethrin Pyrethroid) for his garden every 3 weeks and his last use of insecticide was 2 days ago. He denied using proper protection and reported about 2-3 weeks ago he had an episode of dizziness after dusting his Garden vegetables.

Management/outcome/follow up: Patient was treated conservatively. He did not require Atropine administration. He was observed overnight with the following day stress test and Echocardiography which were unremarkable. He was instructed on using protective clothing while using the insecticide. He was discharged with no future complications.

References and Resources

1. https://www.sciencedirect.com/science/article/pii/S2214750020304479#:~:text=
   Cypermethrin%20poisoning%20can%20present%20as,neurological%2C%20gastrointestinal%
   20or%20cardiac%20manifestations.&text=Prolonged%20bradycardia%20following%20acute%
   20oral%20intoxication%20with%20cypermethrin%20is%20a%20rare%20entity.
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286848/