Electrocardiogram Abnormality in Poisoned Patients with Tricyclic Antidepressant

Background: A wide variety of electrocardiogram (ECG) changes can manifest with antidepressant drugs, occurring at both therapeutic doses and toxic levels. Notably, ECG abnormalities like wide QRS and QT prolongation may be observed in poisoned patients with tricyclic antidepressants (TCAs), indicating severe conditions that necessitate the implementation of cardiac monitoring systems. This study aimed to investigate ECG Abnormality in poisoned patients with tricyclic antidepressants. Methods: This retrospective patient record study was conducted at Razi Hospital in Ahvaz, Iran, from ۲۰۰۶ to ۲۰۰۹. Patient information was extracted from hospital medical records after the established protocol. The chi-square test was employed for initial analysis; subsequently, logistic regression was applied to identify risk factors associated with abnormal ECG findings. We analyzed the data using SPSS (Version ۱۹; IBM) statistical software. P < ۰.۰۵ was defined as statistically significant. Results: Among the ۲۱۰ poisoned patients, comprising ۸۸ men (۴۱.۹%) and ۱۲۲ women (۵۸.۱%), the majority fell within the age range of ۱۵ to ۲۵ years. In our study, the most commonly ingested drugs by poisoned patients were amitriptyline in ۱۳۴ patients (۶۳.۸%) and nortriptyline in ۴۲ patients (۲۰%). A significant portion of ۱۳۷ patients (۶۵.۲%) exhibited poisoning symptoms within ˂ ۶ hours, while ۷۳ patients (۳۴.۸%) showed symptoms between ۶ and ۲۴ hours. Our findings indicated that the initial symptoms in poisoned patients included a decreased level of consciousness in ۱۶۸ patients (۸۰%), nausea and vomiting in ۲۰ patients (۹.۵%), and various other symptoms. Notably, our results revealed ECG changes in ۷۰ patients, with ۳۲ patients (۱۵.۲%) showing a QRS widening (> ۰.۱sec), ۵ patients (۲.۴%) displaying a tall R wave in aVR, ۵ patients (۲.۴%) exhibiting right axis deviation, and other observed changes. Conclusion: QRS widening in poisoned patients with tricyclic antidepressants is more frequently observed in symptomatic patients, highlighting the importance of ECG screening in these patients.

کلیدواژه ها:

ECG changes ، TCA poisoning ، Overdose ، Suicide