Short cases in cardiology
Abnormal atrial and ventricular repolarisation resembling myocardial injury after tricyclic antidepressant drug intoxication
E Zakynthinos, T Vassilakopoulos, C Roussos, S Zakynthinos
Intensive Care Unit,
"Evangelismos" Hospital, Ipsilantou st, 45-47, 10675, Athens,
Greece
Correspondence to: Dr E Zakynthinos
Accepted 6 September 1999
| The first 150 words of the full text of this article appear below. |
A 44 year old woman was admitted to our intensive care unit five hours after ingestion of amitriptyline. She was comatose (Glasgow coma score 3) with dilated pupils non-reactive to light and accommodation. Biochemical findings and serum electrolytes were normal. Arterial blood gas measurements revealed a slight metabolic acidosis. She was immediately intubated and mechanically ventilated. Gastric lavage was performed for gastrointestinal decontamination followed by the administration of activated charcoal. She recovered after 10 days in the intensive care unit with no apparent neurological sequelae.
The admission ECG showed sinus tachycardia (125 beats/min) with a few
supraventricular premature beats, QRS interval widening of 150 ms
resembling right bundle branch block (RBBB), and a prolonged QT
interval (QT 360, corrected QT (QTc) 520 ms). ST segment
elevation was noted in the left limb leads (I, aVL) (fig 1). After 16 hours, a new ST segment elevation was noted in precordial leads V1 and V2. Serial ECGs
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- Pseudo Brugada or true Brugada revealed by tricyclic agents?
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