Serial Monitoring of Lead aVR in Patients with Prolonged Unconsciousness Following Tricyclic Antidepressant Overdose
نویسندگان
چکیده
Severe cardiac and neurologic toxicities of tricyclic antidepressant (TCA) overdose have been reported since the introduction of TCAs in 1950s. Despite the decreased numbers of TCA overdoses, the mortality and morbidity rates of TCA overdose have remained constantly high. Clinical manifestations of TCA overdose are characterized by unconsciousness and specific electrocardiography (ECG) abnormalities such as prolongation of the PR and QTc intervals, widening of the QRS duration, and an increased R wave and R/S ratio in lead aVR. We report a case with unusually prolonged unconsciousness without initial stem reflexes for 7 days and multiple ECG abnormalities following TCA overdose. It is suggested that the serial monitoring of R wave and R/S ratio in lead aVR might be informative in predicting recovery from toxicity following TCA overdose.
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Comment on "Serial Monitoring of Lead aVR in Patients with Prolonged Unconsciousness Following Tricyclic Antidepressant Overdose"
1 Based on the single case reported by the authors, they suggested that the decrease in the height of R wave and R/S ratio in lead aVR may be related to the level of consciousness and be informative in predicting recovery from toxicity following tricyclic antidepressant (TCA) overdose. 1 I think there are a few problems with this suggestion. For instance, the reason for altered consciousness in...
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