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. 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.

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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

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