Article Text

Download PDFPDF
Collapse in the elderly: rivastigmine-induced heart block and a literature review of the pharmacology of acetylcholinesterase inhibitors used in Alzheimer’s disease
  1. Olushola Alonge1,
  2. Fahad Mujtaba Iqbal2,
  3. Elzbieta Cifonelli1
  1. 1 Senior Health Department, St Georges University Hospital, London, UK
  2. 2 Department of Medicine, Keele University, Newcastle under Lyme, UK
  1. Correspondence to Dr Olushola Alonge, olushola.alonge{at}


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.

  • arrhythmias
  • perioperative care
  • unwanted effects / adverse reactions
  • dementia, alzheimer’s type
  • safety
View Full Text

Statistics from


  • Contributors OA identified the case as an excellent learning opportunity and conceived the idea to write it up as a case report. OA discussed this with the patient and her next of kin and obtained the required patient consent. She also wrote the initial draft and did part of the background literature review. FMIqbal edited the first draft and also made a significant contribution to the literature search and review. He also made significant revisions and delivered an amended draft. EC was the supervising consultant involved in the patient’s management and provided critical revision of the manuscript. All named authors contributed towards the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.