since the introduction of our local manufacturing of terfenadine, we have observed and expressed our concern about a small but increasing number of serious ventricular arrhythmias associated with the use of this non sedating antihistamine. in january 1997 a case of torsade de pointes ventricular tachycardia was detected in a previously healthy woman taking terfenadine with erythromycin. electro...

BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) and venlafaxine have been regarded as less toxic in overdose than tricyclic antidepressants (TCAs). Within the TCAs, dothiepin has greater toxicity. Venlafaxine may be more toxic than SSRIs. AIM To assess the toxicity in overdose of venlafaxine and SSRIs compared to TCAs, and of dothiepin compared to other TCAs. DESIGN Cohort study ...

A 55 year old man with history of palpitation was referred for electrophysiologic study. Baseline ECG, physical examination and transthoracic echocardiographic study were normal. Electrophysiologic study revealed normal AH and HV intervals. Pacing of right atrium with a cycle length of 300 msec showed 2:1 AV block. AH interval was 252 msec and the block was infra-his (Figure 1). With continual ...

Right ventricular (RV) pacing produces an iatrogenic form of left bundle branch block (LBBB). Intrinsic LBBB (I-LBBB) can cause adverse hemodynamic effects due to dyssynchrony, mainly in patients with heart failure and reduced ejection fraction (HFrEF). Although RV is thought create a similar activation pattern as LBBB, some studies suggest apical be harmful even I-LBBB. Currently, the mechanis...

BACKGROUND AND AIM Effectiveness of implantable cardioverter-defibrillators (ICD) in patients with reduced left ventricular ejection fraction after myocardial infarction has been documented in large randomised trials. We analysed the predictive value of clinical factors at the time of implantation for adequate ICD interventions and mortality risk. METHODS We analysed 121 consecutive patients ...

AIM Tricyclic antidepressant (TCA) overdose is generally associated with central nervous system (CNS) and cardiovascular toxicity manifested by seizure, electrocardiographic (ECG) abnormalities and arrhythmia. The objective of this study was to determine whether TCA toxicity would be reduced in patient where benzodiazepine (BDZ) was co-ingested with TCA. DESIGN Patients who were diagnosed to ...

Diphenhydramine toxicity commonly manifests with antimuscarinic features, including dry mucous membranes, tachycardia, urinary retention, mydriasis, tachycardia, and encephalopathy. Severe toxicity can include seizures and intraventricular conduction delay. We present here a case of a 23-year-old male presenting with recurrent seizures, hypotension and wide complex tachycardia who had worsening...

Digoxin is rarely used in modern cardiovascular disease management. Therefore, digoxin toxicity has been infrequently encountered and it paramount to diagnose a timely fashion. Bidirectional ventricular tachycardia an unusual arrhythmia wherein every other beat different QRS axis as travels alternately down conduction pathways. The can be manifestation of myocarditis, myocardial infarct, Anders...

Encainide, a class IC antiarrhythmic agent, has been associated with proarrhythmic responses of ventricular tachycardia and fibrillation requiring defibrillation in patients. We examined the short-term effects of intravenous encainide and its two major metabolites, O-demethyl-encainide (ODE) and 3-methoxy-ODE (MODE), on the energy requirements for successful defibrillation in 25 pentobarbital-a...