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[Electrocardiographic changes that wrongly indicate severe myocardial ischemia in patients treated with
1Regione Marche-Azienda Sanitaria n. 2 Ospedale di Urbino, Reparto di Cardiologia.
Insights
Tricyclic antidepressants can mimic ischemic heart damage on electrocardiograms (ECGs), complicating diagnosis. Discontinuing this medication resolved the ECG abnormalities, confirming its interference with myocardial electrical activity.
Area of Science:
- Cardiology
- Clinical Pharmacology
Background:
- Electrocardiogram (ECG) alterations, such as negative T waves, can suggest ischemic heart damage.
- Diagnostic challenges arise when clinical presentation and initial tests do not align with suspected ischemic cardiopathy.
Abstract:
The paper reports the case of a female 54-years old admitted to UTIC following recent episodes of precordial pain associated with major ECG alterations (negative T wave in precordial derivations) which appeared to indicate ischemic damage. The normality of laboratory tests and the mechanical function of the left ventricle studied using echo-Doppler raised doubts regarding the diagnosis of ischemic cardiopathy. After an interval of 2 months (during which the patient was constantly asymptomatic), owing to the persistence of ECG alterations during the recovery stage, an effort test was performed using thallium; the latter was normal and thus enabled the ischemic genesis of these alterations to be excluded. The suspension of antidepressive therapy with tricyclic agents, which the patient had taken for years, was followed after a few months by the stabilisation of ECG. This confirms that tricyclic antidepressive agents may significantly interfere with the electric activity of the myocardial cells, provoking considerable difficulties for a correct diagnosis.