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Tricyclic Antidepressants (Intoxication)

Tricyclic antidepressants Overdose (Sodium-Channel Blocker Toxicity)

Depression

clinical depression, unipolar disorder, recurrent depression
  • Requires at least 5 of the following symptoms for 2 weeks:
    • sadness, pessimism, feeling of failure, self-hatred, guilt, frequent crying, reduced self-esteem, suicidal thoughts, loss of interest, insomnia, etc.
  • Depression is a serious mental disorder affecting
    • 20% of women
    • 12% of men
  • It is a neurotransmitter imbalance in the brain:
    • serotonin, norepinephrine, and dopamine

Tricyclic Antidepressants

ECG antidepressant drug prothiaden

Sodium Channel Blockers

  • A large group of drugs that block sodium channels
  • Slow down depolarization of the action potential
  • Characteristic ECG changes occur during intoxication

  • Sodium Channel Blockers:
    • Tricyclic Antidepressants (most commonly used sodium channel blockers)
    • Antiarrhythmics (Ia, Ic)
    • Local Anesthetics
    • Antimalarials
    • Propranolol
    • Carbamazepine
    • Quinine

ECG and Sodium Channel Blockers (Intoxication)

ECG tricyclic Overdose (Sodium channel blocker toxicity), terminal R wave, R/S ratio aVR

ECG sinus tachycardia, broad QRS complexs, postitive R wave - aVR, tricyclic antidepressant (TCA) overdose, sodium channel blocker toxicity

Tricyclic Antidepressants (Intoxication)



ECG sinus tachycardia, first degree av block, prolonged PQ interval, broad qrs, dominant R aVR, prothiaden, tricyclic antidepressant (TCA) overdose, sodium channel blocker toxicity

ECG 1/3: Tricyclic Antidepressants (Intoxication)



ECG sine wave (hyperkalaemia), tricyclic antidepressant (TCA) overdose, sodium channel blocker worsening toxicity

ECG 2/3: Tricyclic Antidepressants (Progression of Intoxication)

  • This is the same patient as in the previous ECG
  • Progression of tricyclic antidepressant intoxication
    • QRS is wider > 160ms
  • QRS complexes resemble a sine wave (lead I), similar to hyperkalemia


ECG tricyclic antidepressant (TCA) overdose, sodium channel blocker toxicity, resolution TCA toxicity with treatment (bicarbonate and hyperventilation)

ECG 3/3: Tricyclic Antidepressants (Post-Treatment of Intoxication)



ECG tricyclic antidepressant (TCA) overdose, toxicity, sinus bradycardia, broad qrs complexes

Tricyclic Antidepressants (Intoxication)

  • Sinus Tachycardia (140/min.)
  • Extremely wide QRS > 0.16s (lead II)
  • Terminal R´ > 3mm (aVR)
  • The patient was severely overdosed with a tricyclic antidepressant (Prothiaden)


ECG flecainid poisoning, sodium channel blocker toxicity, sinus tachycardia, broad qrs, terminal r aVR

Flecainide (Intoxication)



ECG flecainid poisoning, toxicity, overdose, sinus rhytm, broad qrs, giant r aVR

Flecainide (Intoxication)

  • Sinus Rhythm (90/min.)
  • Extremely wide QRS > 160ms (lead II)
  • Terminal R (R´) > 3mm in aVR
  • Flecainide is an antiarrhythmic drug of the Ic group (sodium channel blocker)
    • The intoxication is more severe than in the previous ECG (wider QRS complexes)



Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers





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Home /

Tricyclic Antidepressants (Intoxication)

Tricyclic antidepressants Overdose (Sodium-Channel Blocker Toxicity)

Depression

  • Requires at least 5 of the following symptoms for 2 weeks:
    • sadness, pessimism, feeling of failure, self-hatred, guilt, frequent crying, reduced self-esteem, suicidal thoughts, loss of interest, insomnia, etc.
  • Depression is a serious mental disorder affecting
    • 20% of women
    • 12% of men
  • It is a neurotransmitter imbalance in the brain:
    • serotonin, norepinephrine, and dopamine
clinical depression, unipolar disorder, recurrent depression

Tricyclic Antidepressants

  • Block the reuptake of neurotransmitters:
    • This increases their concentration, which has an antidepressant effect

  • Additionally, they are also sodium channel blockers
ECG antidepressant drug prothiaden

Sodium Channel Blockers

  • A large group of drugs that block sodium channels
  • Slow down depolarization of the action potential
  • Characteristic ECG changes occur during intoxication

  • Sodium Channel Blockers:
    • Tricyclic Antidepressants (most commonly used sodium channel blockers)
    • Antiarrhythmics (Ia, Ic)
    • Local Anesthetics
    • Antimalarials
    • Propranolol
    • Carbamazepine
    • Quinine

ECG and Sodium Channel Blockers (Intoxication)

ECG tricyclic Overdose (Sodium channel blocker toxicity), terminal R wave, R/S ratio aVR


ECG sinus tachycardia, broad QRS complexs, postitive R wave - aVR, tricyclic antidepressant (TCA) overdose, sodium channel blocker toxicity

Tricyclic Antidepressants (Intoxication)



ECG sinus tachycardia, first degree av block, prolonged PQ interval, broad qrs, dominant R aVR, prothiaden, tricyclic antidepressant (TCA) overdose, sodium channel blocker toxicity

ECG 1/3: Tricyclic Antidepressants (Intoxication)



ECG sine wave (hyperkalaemia), tricyclic antidepressant (TCA) overdose, sodium channel blocker worsening toxicity

ECG 2/3: Tricyclic Antidepressants (Progression of Intoxication)

  • This is the same patient as in the previous ECG
  • Progression of tricyclic antidepressant intoxication
    • QRS is wider > 160ms
  • QRS complexes resemble a sine wave (lead I), similar to hyperkalemia


ECG tricyclic antidepressant (TCA) overdose, sodium channel blocker toxicity, resolution TCA toxicity with treatment (bicarbonate and hyperventilation)

ECG 3/3: Tricyclic Antidepressants (Post-Treatment of Intoxication)



ECG tricyclic antidepressant (TCA) overdose, toxicity, sinus bradycardia, broad qrs complexes

Tricyclic Antidepressants (Intoxication)

  • Sinus Tachycardia (140/min.)
  • Extremely wide QRS > 0.16s (lead II)
  • Terminal R´ > 3mm (aVR)
  • The patient was severely overdosed with a tricyclic antidepressant (Prothiaden)


ECG flecainid poisoning, sodium channel blocker toxicity, sinus tachycardia, broad qrs, terminal r aVR

Flecainide (Intoxication)



ECG flecainid poisoning, toxicity, overdose, sinus rhytm, broad qrs, giant r aVR

Flecainide (Intoxication)

  • Sinus Rhythm (90/min.)
  • Extremely wide QRS > 160ms (lead II)
  • Terminal R (R´) > 3mm in aVR
  • Flecainide is an antiarrhythmic drug of the Ic group (sodium channel blocker)
    • The intoxication is more severe than in the previous ECG (wider QRS complexes)



Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers