Early and prolonged ECG alterations resembling a myocardial injury after severe amitriptyline poisoning

摘要

A 63-year-old woman was admitted to our Intensive Care Unit (ICU) four hours after ingesting 7000 mg of amitriptyline as a suicide attempt. She had no history of diabetes, heart disease or other illness, except for a major depressive syndrome, treated with amitriptyline and clomipramine. She was found at home comatose (Glasgow Coma Score 3) with normal pupils reactive to light. Blood pressure was 90/80, the heart rate was 110 beats/min and the SpO2 was 80%. In the Emergency Room, she was tracheally intubated and was admitted to the ICU. Aiming to remove as more pills as possible, a gastric lavage was performed, followed by the administration of active charcoal. Arterial blood gases, pH, serum electrolytes and myocardial enzymes were normal. Toxicological studies were negative for other substance abuse. A baseline ECG tracing obtained from a previous admission to hospital for a surgical intervention was available for comparison. It showed a sinus tachycardia and an anterior left hemiblock. The 12-lead ECG (Figure 1, column 2) on admission showed sinus tachycardia, anterior left hemiblock, prolonged QT interval (360 ms), QRS widening (140 ms) and a marked ST tract elevation in leads V1-V6 and aVR.