IVCD - Tricyclic Overdose

Report:

Sinus tachycardia 118/min

Right axis deviation +110o

Intraventricular conduction delay

Mildly prolonged QTc (QT 0.33”, QTc 0.46”)

Comment:

This is a fairly typical trace of a tricyclic overdose. The IVCD pattern suggests RBBB, but the QRS prolongation is not confined to its terminal forces, as in proper RBBB. The overall QRS duration is barely over 0.12” – an indicator of uncomplicated recovery74. Hæmodynamics and the state of consciousness may be a better guide than ECG in this respect: those that come to grief with “late arrhythmias” almost invariably show their hand though coma, fits and shock in the first place. Some also have typical fascicular blocks and are hard to interpret75.

The ECG was almost normal two days later (Fig 104a).

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