Thrita. 2015 December; 4(4): e23041. doi: 10.5812/thrita.23041 Published online 2015 December 12. Case Report Abrupt Palpitation Following Taking Regular Doses of Oxazepam: A Rare Case Report Seyed Hassan Seyed Sharifi, 1 Taha Mohammad Rezapour, 1 and Mohsen Yaghubi 2,* 1 Student Research Committee, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, IR Iran 2 Intensive Cardiac Care Unit, 9 Day Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, IR Iran *Corresponding author: Mohsen Yaghubi, Intensive Cardiac Care Unit, 9 Day Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, IR Iran. Tel: +98-5152226016, Fax: +98-5152239311, E-mail: n.m.yaghubi@gmail.com Received 2014 August 25; Revised 2015 September 25; Accepted 2015 October 1. Abstract Introduction: The sensation of palpitations may either be the initial or the only symptom of cardiac arrhythmia. We describe a case of a visible clear temporal relationship between standard doses of oxazepam and palpitation. Case Presentation: A 48-year-old man presented to the cardiac care unit with systolic heart failure. He was commenced on a medication regimen of routine drugs of patient’s heart failure and oxazepam. After taking the second dose of oxazepam, he experienced palpitations. These were associated with lightheadedness, and retrosternal and upper abdominal discomfort. His electrocardiography (ECG) demonstrated atrial fibrillation (AF) with nonpathological premature ventricular contractions (PVCs) in trace. His symptoms ceased upon the cessation of the oxazepam therapy. Conclusions: Atrial fibrilation is the most common sustained rhythm disorder with serious clinical consequences such as hemodynamic impairment and ischemic stroke. Cardiologists and nurses should be aware of the possibility of adverse reactions when oxazepam is prescribed as hypnotic. Keywords: Oxazepam, Atrial Fibrilation, Palpitation Copyright © 2015, Thrita. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. 1. Introduction Patients with heart failure (HF) have difficulty maintain- ing adequate oxygenation; therefore, they are likely to be restless and anxious and feel overwhelmed by breathless- ness. These symptoms tend to intensify at night (1). Emo- tional stress stimulates the sympathetic nervous system, which causes vasoconstriction, elevated arterial pres- sure, and increased heart rate. This sympathetic response increases the amount of work that the heart has to do. By decreasing anxiety, the patient’s cardiac work also is de- creased (2, 3). Oxygen and other medication, such as anxiolytic agents, may be administered during an acute event to diminish the work of breathing and increase the patient’s comfort. In this case report, we describe a case of cardiac palpita- tions that temporally appears to be caused by standard doses of oxazepam, an event that has not been previously described in the medical literature. 2. Case Presentation A 48-year-old man, weighing 55 kg, presented to cardi- ac care unit (CCU) with a history of systolic heart failure. He reported class 3 pectoris angina (CCS3) and signifi- cant dyspnea on exertion (DOE) and no history of hos- pitalization for his compliant. In physical examination, in heart sound auscultation, we found mitral click in midsystolic phase. He had a history of using drugs such as captopril (ACE i), carvedilol (β-blocker), hydrochloro- thiazide (diuretic), and ASA 80 mg, and had no allergies. There was also no significant family medical history. A clinical diagnostic evaluation (echocardiography) showed that 45% ejection fraction and mild mitral re- gurgitation and his cardiac biomarker analysis showed that ck-MB is in a normal range (below 25) and tropo- nin I is negative. Complete blood count (CBC) diff values were normal and biochemistry levels showed normal levels, except potassium level (K = 5.1 mEq/L). He had not any evidence of abnormal conductivity pathways; how- ever, he had a degree 1 AV block (PR interval = 24 ms) in his electrocardiography (ECG). He was commenced on a regimen of lozartan 25 mg; tds, metoprolol 50 mg; bid, ASA 80 mg; qd, hydrochlortiazide 5 mg; qd, nitrocantine 2.6 mg; bid, salbutamol 2 puff; tid and prn, and oxazepam 10 mg; qhs. His last vital signs before drug administration were heart rate, 67 bpm, re- spiratory rate, 17 RR, blood pressure = 137/72 mmHg, and axillary temperature measurement was 36.6˚C. The last ECG before drug administration has shown in (Figure 1).