Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Dec;5(4):247-50.
doi: 10.4306/pi.2008.5.4.247. Epub 2008 Dec 31.

Serial Monitoring of Lead aVR in Patients with Prolonged Unconsciousness Following Tricyclic Antidepressant Overdose

Kyoung Ho Choi  1 , Kyoung-Uk Lee
Affiliations

Serial Monitoring of Lead aVR in Patients with Prolonged Unconsciousness Following Tricyclic Antidepressant Overdose

Kyoung Ho Choi et al. Psychiatry Investig. 2008 Dec.

Abstract

Severe cardiac and neurologic toxicities of tricyclic antidepressant (TCA) overdose have been reported since the introduction of TCAs in 1950s. Despite the decreased numbers of TCA overdoses, the mortality and morbidity rates of TCA overdose have remained constantly high. Clinical manifestations of TCA overdose are characterized by unconsciousness and specific electrocardiography (ECG) abnormalities such as prolongation of the PR and QTc intervals, widening of the QRS duration, and an increased R wave and R/S ratio in lead aVR. We report a case with unusually prolonged unconsciousness without initial stem reflexes for 7 days and multiple ECG abnormalities following TCA overdose. It is suggested that the serial monitoring of R wave and R/S ratio in lead aVR might be informative in predicting recovery from toxicity following TCA overdose.

Keywords: Electrocardiography; Overdose; Tricyclic antidepressant; Unconsciousness.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Our patient's ECG at the First, Third, and Sixth hospital day following TCA overdose showed the changes of amplitude of R wave and R/S ratio in lead aVR. In our case, the values of amplitude of R wave and R/S ratio in lead aVR tended to decline in proportion to improvements in GCS scores and his clinical condition. The oblique arrow in figure indicates the prominent and right axis deviated R wave in lead aVR. ECG: electrocardiography, TCA: Tricyclic Antidepressant.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Dorpat TL, Ripley HS. A study of suicide in the Seattle area. Compr Psychiatry. 1960;1:349–359. - PubMed
    1. Isometsä E, Henriksson M, Marttunen M, Heikkinen M, Aro H, Kuoppasalmi K, et al. Mental disorders in young and middle aged men who commit suicide. BMJ. 1995;310:1366–1367. - PMC - PubMed
    1. Beautrais AL, Joyce PR, Mulder RT, Fergusson DM, Deavoll BJ, Nightingale SK. Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study. Am J Psychiatry. 1996;153:1009–1014. - PubMed
    1. Jick SS, Dean AD, Jick H. Antidepressants and suicide. BMJ. 1995;310:215–218. - PMC - PubMed
    1. Liebelt EL. Cyclic Antidepressants. In: Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, Nelson LS, editors. Goldfrank's Toxicologic emergencies. New York: McGraw-Hill; 2006. pp. 1083–1097.