22 year old female brought in semi-conscious by boyfriend.
BP 90/60, HR 150/min.
Hypocount : 5.2 mmol
10 minutes later she developed a generalized tonic-clonic seizure.
What does the ECG show?
What is the likely underlying cause?
Answer : Tricyclic Antidepressant (TCA) Overdose
The ECG shows a broad-complex tachycardia which raises the suspicion of a VT (ventricular tachycardia). This is unusual in a young female patient, as VT usually occurs in the setting of more elderly patients with underlying cardiac disease.
Involvement of the cardiovascular and neurological systems in a young patient who presents with in this manner (brought in by boyfriend) should alert us to the possibility of a drug-overdose, especially that of tricyclic antidepressants (TCA) such as amitriptyline.
Presenting features of TCA toxicity may include:
Cardiovascular : Palpitation, Chest pain, Hypotension
CNS : Convulsion, Decrease mental status, Respiratory depression, Drowsiness, Coma
Peripheral autonomic system : Dry mouth, Dry skin, Urinary retention, Blurred vision
Treatment
· ICU management
· Support airway and vital signs
· Activated charcoal for GI decontamination
· IV Sodium Bicarbonate esp. in prolonged QRS
· Benzodiazepines for seizures
· Consider hemodialysis
This website is absolutely fascinating! Doesn't look like you've posted in a long time... why not? I'm not in the medical profession, but I love the study of medicine, and find this to be very interesting. On this particular EKG, I thought it might be a drug overdose. I was surprised to find I was right, and further surprised to discover that you can tell what KIND of overdose?! very interesting.
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