Brugada electrocardiographic pattern induced by amitriptyline overdose
Chandrasekar Palaniswamy1, Dhana Rekha Selvaraj, Tarun Chugh
1Department of Medicine, New York Medical College, Valhalla, NY, USA. drpchandrasekar@gmail.com
American Journal of Therapeutics
|July 29, 2009
Summary
Tricyclic antidepressant overdose can cause fatal poisoning due to heart toxicity. This case highlights how sodium bicarbonate infusion resolved a Brugada electrocardiographic pattern in amitriptyline poisoning.
Area of Science:
- Cardiology
- Clinical Toxicology
- Pharmacology
Background:
- Tricyclic antidepressants (TCAs) are frequently implicated in fatal drug poisonings.
- Cardiovascular toxicity, including arrhythmias and hypotension, is a primary concern in TCA overdose.
- The mechanism involves cardiac sodium channel blockade, potentially leading to electrocardiographic abnormalities like the Brugada electrocardiographic pattern (BEP).
Observation:
- A patient presented with a Brugada electrocardiographic pattern (BEP) following a significant amitriptyline overdose.
- This case explores the under-investigated relationship between Brugada syndrome and TCAs.
Findings:
- Continuous sodium bicarbonate infusion was administered as a treatment for the TCA overdose.
- The treatment resulted in the successful resolution of the Brugada electrocardiographic pattern (BEP).
Implications:
- Sodium bicarbonate may be an effective treatment for TCA-induced Brugada electrocardiographic pattern.
- Further research is warranted to understand the specific interactions between TCAs and Brugada syndrome.
- This finding could inform clinical management strategies for patients with TCA overdose and cardiac conduction abnormalities.
More Related Videos
Related Concept Videos
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
01:30Toxidromes: Clinical Features
Toxidromes are specific patterns of symptoms resulting from toxic substance exposure. They help in the identification and treatment of poisoning. The symptoms of each toxidrome group indicate poisoning by a certain class of chemicals or drugs.1. Sympathomimetic: Stimulates the sympathetic nervous system. Symptoms include agitation, increased heart rate (HR), blood pressure (BP), respiratory rate (RR), temperature, and pupil size. Drugs like cocaine and amphetamines, along with tremors and...
01:29Disturbances in Heart Rhythm
Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
01:29Dysrhythmias III: Characteristics of Dysrhythmias
Dysrhythmias, also known as arrhythmias, are irregular heart rhythms that result from abnormal electrical activity in the heart, affecting its ability to circulate blood efficiently. Tachyarrhythmias, a subset of dysrhythmias, are characterized by abnormally fast heart rates exceeding 100 beats per minute. Here are some types of tachyarrhythmias with their distinct ECG features:Sinus Tachycardia:Sinus tachycardia presents a regular heart rhythm with an increased rate of 101-180 beats per minute.
01:28Dysrhythmias II: Classification of Tachyarrhythmias
Tachyarrhythmias are a type of dysrhythmia where the heart rate exceeds 100 beats per minute. Here are some common types of tachyarrhythmias:Sinus TachycardiaSinus tachycardia originates from increased impulses from the sinus node, leading to an elevated heart rate. It is often triggered by stress, fever, or exercise.Patients may experience palpitations, a sensation of a racing heart, dizziness, and chest discomfort.Causes and Risk Factors: Common causes include physical exertion, emotional...