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Neuroleptic malignant syndrome (NMS) is a rare, potentially lethal, idiosyncratic disorder related to the use of neuroleptic agents that produce dopaminergic blockade. The disorder is characterised by several cardinal features, including autonomic dysfunction, altered mental status, muscular rigidity and hyperthermia. The common cardiac feature mentioned in various diagnostic criteria for NMS is tachycardia. We report a 27 year old lady who presented with cardinal features of NMS. Soon after presentation, she developed severe bradycardia (lowest 35/min) followed by documented episodes of sinus arrest lasting up to 9 seconds. She was managed in intensive care unit with temporary pacemaker and recovered after 2 weeks of intensive management. We conclude that although NMS is usually associated with tachycardia, one might face transient episodes of prolonged sinus arrest that pose a significant management challenge for physicians.

Recurrent episodes of sinus arrest in neuroleptic malignant syndrome: A management challenge for physicians