Very interesting case
A 44-year-old female was brought to our emergency department due to impaired consciousness. On arrival, her Glasgow Coma Scale score was 6. Her blood pressure was 102/60 mmHg, her heart rate was 132 bpm, her respiratory rate was 18 breaths per minute, and her body temperature was 36.1 °C
Laboratory tests did not reveal any significant abnormalities in electrolyte levels.
Electrocardiograms obtained on arrival.
A wide QRS tachycardia with right bundle branch block pattern, extreme right axis deviation, prolonged QTc interval, and high amplitude of R wave in lead aVR were seen.
B. Electrocardiograms obtained one hour after sodium bicarbonate infusion. The QRS width and QTc interval were narrowing and tachycardia was resolved.
Acute tricyclic antidepressant (TCA) poisoning. The patient had ingested 1000 mg of amitriptyline hydrochloride in an attempt to commit suicide, and a urine test for TCA was positive. Intensive care improved her condition gradually, after which she was discharged five days after admission.
For patients with these ECG findings or hemodynamic instability, sodium bicarbonate infusion is indicated because it can stabilize myocardial sodium channels by increasing the sodium level and reducing the free drug level via serum alkalization .
Given that there are specific treatments for TCA poisoning , it should be considered one of the causes of wide QRS tachycardia with an RBBB pattern.
A 44-year-old female was brought to our emergency department due to impaired consciousness. On arrival, her Glasgow Coma Scale score was 6. Her blood pressure was 102/60 mmHg, her heart rate was 132 bpm, her respiratory rate was 18 breaths per minute, and her body temperature was 36.1 °C
Laboratory tests did not reveal any significant abnormalities in electrolyte levels.
Electrocardiograms obtained on arrival.
A wide QRS tachycardia with right bundle branch block pattern, extreme right axis deviation, prolonged QTc interval, and high amplitude of R wave in lead aVR were seen.
B. Electrocardiograms obtained one hour after sodium bicarbonate infusion. The QRS width and QTc interval were narrowing and tachycardia was resolved.
Acute tricyclic antidepressant (TCA) poisoning. The patient had ingested 1000 mg of amitriptyline hydrochloride in an attempt to commit suicide, and a urine test for TCA was positive. Intensive care improved her condition gradually, after which she was discharged five days after admission.
For patients with these ECG findings or hemodynamic instability, sodium bicarbonate infusion is indicated because it can stabilize myocardial sodium channels by increasing the sodium level and reducing the free drug level via serum alkalization .
Given that there are specific treatments for TCA poisoning , it should be considered one of the causes of wide QRS tachycardia with an RBBB pattern.
