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

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.

• Publication year

  2008

• Venue

  Psychiatry Investigation

• Publication date

  2008-12-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.4306/pi.2008.5.4.247PMID 20046346PMCID 2796009
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Coma with ECG abnormalities: consider tricyclic antidepressant intoxication.

  2007cited by this paper
• Trends in antidepressant overdoses

  2007cited by this paper
• Electrocardiographical case. A man found unconscious.

  2006cited by this paper
• Electrocardiographic applications of lead aVR.

  2006cited by this paper
• Association between antidepressant prescribing and suicide in Israel

  2006cited by this paper
• Tricyclic Antidepressant Poisoning

  2005cited by this paper
• Tricyclic Antidepressant Poisoning

  2005cited by this paper
• Antidepressants and suicide risk in the United States, 1985-1999.

  2004cited by this paper
• Association between antidepressant prescribing and suicide in Australia, 1991-2000: trend analysis

  2003cited by this paper
• Tricyclic antidepressant overdose: a review

  2001influential reference
• Prolonged coma and loss of brainstem reflexes following amitriptyline overdose.

  2001cited by this paper
• Prolonged coma and loss of brainstem reflexes following amitriptyline overdose.

  2001cited by this paper
• Antidepressant drug use in Italy since the introduction of SSRIs: national trends, regional differences and impact on suicide rates

  1999cited by this paper
• TCA overdose.

  1999cited by this paper
• ECG abnormalities in tricyclic antidepressant ingestion.

  1999cited by this paper
• TCA OVERDOSE. AUTHORS' REPLY

  1999cited by this paper
• Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study.

  1996cited by this paper
• ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity.

  1995cited by this paper
• Antidepressants and suicide

  1995cited by this paper
• Mental disorders in young and middle aged men who commit suicide

  1995cited by this paper
• What are "cyclic" antidepressants?

  1990influential reference
• Level of consciousness as a predictor of complications following tricyclic overdose.

  1987cited by this paper
• Goldfrank's Toxicologic emergencies

  1986cited by this paper
• A study of suicide in the Seattle area.

  1960cited by this paper

• Bizarre wide complex tachycardia caused by sodium channel toxicity secondary to the management of status epilepticus: Case report

  2022cites this paper
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  2020cites this paper
• Toxicologic Confounders of Brain Death Determination: A Narrative Review

  2020cites this paper
• A Case of Amitriptyline-induced Myocarditis

  2018cites this paper
• Loss of brainstem reflexes: not always an ominous sign.

  2018cites this paper
• The Role of Sodium Bicarbonate in the Management of Some Toxic Ingestions

  2017cites this paper
• Effect of intravenous midazolam on cardiac parameters in acute tricyclic antidepressants poisoning

  2016cites this paper
• High Prevalence of Psychotropics Overdose among Suicide Attempters in Korea

  2015cites this paper
• Complete Absence of Precordial R Waves Due to Absence of Left‐Sided Pericardium

  2012cites this paper
• Benzodiazepines co-ingestion in reducing tricyclic antidepressant toxicity.

  2012cites this paper
• Comment on "Serial Monitoring of Lead aVR in Patients with Prolonged Unconsciousness Following Tricyclic Antidepressant Overdose"

  2012cites this paper
• Clinical Value of Lead aVR

  2011cites this paper
• Initial downward deflection in lead aVR in cyclic antidepressant poisoning-S or Q Wave?

  2011cites this paper
• The ‘overly‐sensitive’ heart: sodium channel block and QRS interval prolongation

  2011cites this paper