SINUS BRADYCARDIA IN SUPER VASMOL POISONING: A RARE BUT SIGNIFICANT CLINICAL MANIFESTATION – REPORT OF TWO CASES

Introduction: Super Vasmol, an emulsion-based hair dye containing paraphenylenediamine (PPD), is an emerging cause of suicidal poisoning in developing countries, commonly presenting with cervicofacial oedema, rhabdomyolysis, and acute kidney injury (AKI). Cardiac involvement, though rare, typically manifests as tachycardia or myocarditis. This report highlights sinus bradycardia as an unusual presentation. Case Presentation: Two adult women with Super Vasmol poisoning developed marked sinus bradycardia during hospitalization. Case 1, a 34-year-old woman, presented with mild dysphagia and developed asymptomatic sinus bradycardia (heart rate [HR] 38–50/min) on day 3, resolving by day 6. Case 2, a 30-year-old woman, had mild cervicofacial edema and symptomatic bradycardia (HR 40–50/min) with giddiness and breathlessness on day 3, which normalized by day 6. Both patients recovered with conservative management. Conclusion: Sinus bradycardia is a rare but significant manifestation of Super Vasmol poisoning, potentially linked to PPD-induced cardiotoxicity or other components. Clinicians should recognize this atypical presentation to optimize management and reduce mortality in resource-limited settings where such poisoning is prevalent.