'Brugada ECG' elicited by imipramine overdose
Summary
Brugada ECG patterns can mimic Brugada syndrome but may arise from other causes. This case highlights imipramine overdose as a reversible cause of Brugada ECG, emphasizing prompt treatment with sodium bicarbonate.
Area of Science:
- Cardiology
- Clinical Toxicology
- Pharmacology
Background:
- Brugada syndrome is characterized by ST-segment elevation in right precordial ECG leads.
- The 'Brugada ECG' pattern can be mimicked by various conditions, not exclusively Brugada syndrome.
- Tricyclic antidepressant (TCA) overdose is a known cause of cardiotoxicity, including sodium channel blockade.
Purpose of the Study:
- To report a case of Brugada ECG pattern induced by imipramine overdose.
- To illustrate the reversible nature of imipramine-induced Brugada ECG with appropriate management.
- To highlight the importance of considering drug toxicity in patients presenting with Brugada ECG.
Main Methods:
- Case report of a 66-year-old female patient presenting with coma after imipramine overdose.
- Electrocardiogram (ECG) analysis revealing ST-segment elevation in right precordial and inferior leads.
- Treatment with sodium bicarbonate for managing the cardiotoxic effects of imipramine.
Main Results:
- The patient exhibited a Brugada ECG pattern consistent with sodium-channel blockade.
- ECG abnormalities, including ST-segment elevation, resolved rapidly following sodium bicarbonate administration.
- The case demonstrates imipramine-induced Brugada ECG as a distinct clinical entity.
Conclusions:
- Imipramine overdose can precipitate a Brugada ECG pattern, mimicking Brugada syndrome.
- Sodium bicarbonate is an effective antidote for reversing imipramine-induced cardiotoxicity and ECG changes.
- Differential diagnosis of Brugada ECG should include TCA overdose, especially in acute overdose settings.
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