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. 2013 Jul;2(3):110-3.
doi: 10.4103/2279-042X.122381.

ST-T segment changes in patients with tricyclic antidepressant poisoning

Farzad Gheshlaghi  1 , Mozhgan Karbalayi Mehrizi  2 , Ahmad Yaraghi  1 , Ali Mohammad Sabzghabaee  3 , Forough Soltaninejad  4 , Nastaran Eizadi-Mood  1
Affiliations

ST-T segment changes in patients with tricyclic antidepressant poisoning

Farzad Gheshlaghi et al. J Res Pharm Pract. 2013 Jul.

Abstract

Objective: Tricyclic antidepressant (TCA) poisoning is among highly prevalent and potentially dangerous toxicities. ST-T changes are observed in the electrocardiogram (ECG) of most of TCA poisoned patients. We aimed to study ST-T segment changes in TCA toxicity and its probable relationship with other ECG findings.

Methods: This retrospective study was carried out in Noor and Ali Asghar University Hospital, Isfahan (Iran) in 2012. Patients with TCA toxicity based on the patients' history who had not consumed any cardio-active drugs and did not have a past medical history of cardiovascular disease in the recent 5 years, were randomly selected and investigated. Their demographic and medical data on admission including ECG, age, sex, type and amount of ingested TCA, poisoning severity score, QRS changes, QT interval, heart axis position and R-wave were all recorded. ST-T changes and their relation with other ECG parameters have been determined using statistical analysis.

Findings: Medical records of 272 patients were analyzed. In symptomatic patients, ST change prevalence was 40.8% and T change prevalence was 9.5%. In asymptomatic patients, the frequency of ST and T changes were 4.8% and 0.8%, respectively (P < 0.05). The most common ST and T changes in baseline (on admission) ECG were non-significant elevation (15.4%), significant elevation (11%) in pre-cordial leads, and T-wave flattening (6.6%). A statistically significant correlation was documented between ST segment changes with QRS and R-wave in aVR. The correlation between T-wave changes and R-wave in aVR lead was also significant.

Conclusion: ST-T changes in TCA poisoned patients are more prevalent in symptomatic patients. Obviously for a more definite conclusion, it is necessary to design a prospective study with the control group. This may facilitate a better understanding of ST-T segment changes.

Keywords: Electrocardiogram; poisoning; toxicity; tricyclic antidepressant.

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Conflict of interest statement

Conflict of Interest: None declared.

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References

    1. Wing YK. Recent advances in the management of depression and psychopharmacology. Hong Kong Med J. 2000;6:85–92. - PubMed
    1. Bebarta VS, Maddry J, Borys DJ, Morgan DL. Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose. Am J Emerg Med. 2011;29:645–9. - PubMed
    1. Choy CH, Kitchell AK, Kam CW. Lethal tricyclic antidepressant overdose. Hong Kong J Emerg Med. 2001;8:101–5.
    1. Dart RC, Caravati EM, McGuigan MA. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2004. Medical Toxicology; p. 1914.
    1. Kobayashi K, Miyajima M, Tanaka T, Kumagai K, Hirose Y, Hori Y, et al. Tricyclic antidepressant overdose rescued by percutanenous cardiopulmonary support: Report of two cases. Chudoku Kenkyu. 2011;24:46–50. - PubMed