Loss of Consciousness and Seizure in Patient with Tricyclic Antidepressant Poisoning and with Atyp-ical ECG Changes

Antidepressants can be abused for committing suicide despite effectiveness in treatment of depression. Tricyclic Antidepressants (TCA) were considered the first line of treatment for depression. A ۲۳-year-old woman brought to emergency department by EMS personnel due to convulsion and loss of consciousness. She had taken ۹۰ of pills (Amitriptyline ۷۵ mg) at once to commit suicide. The patient was intubated and connected to the mechanical ventilator and admitted to the women’s toxicity ICU. Over ۴۸-۷۲-hour hospitalization, ECG changes persistent. In this case, ECG changes were in the form of LBBB over view with wide QRS (۱۶۰ msec) and long QTC (۵۲۰ msec). But, the R/S ratio above ۰.۷ and RAD was not observed in patient’s ECG. In the ۴th hospitalization day, QRS waves began to narrow, and on the ۵th day, the patient’s ECG returned to normal completely. In drug poisonings, there are a series of clinical and para-clinical manifestations that can help in the diagnosis of patient. Management of patients should not only rely on clinical or para-clinical sings. In TCA poisoning, ECG changes have no single pattern and can lead to a variety of changes and can also persist for days after poisoning despite the clinical recovery.