ECG of the Week - 18th February 2019 - Interpretation

The following ECG is from a 65yr old male who presented following a large dothiepin overdose.

 

Click to enlarge

Rate:

• 90 bpm

Rhythm:

 

• Regular
• Sinus rhythm 

Axis:

• Normal

Intervals:

• PR - Normal (~200ms)
• QRS - Prolonged (~140ms)
• QT - 400ms (QTc Bazette 490 ms)

Additional:

• Terminal R wave in lead aVR ~4mm
• T wave inversion lead III
• Variable P wave morphology - ? secondary artefact vs conduction abnormality
• Baseline artefact in rhythm strip
• RBBB Morphology

 Interpretation:

• ECG features consistent with TCA overdose and sodium channel toxicity
• QRS Prolongation
• Terminal R wave in lead aVR
• RBBB Morphology

 

What happened ?

 

The patient underwent the following treatment:

• IV Sodium bicarbonate
• RSI
• Post intubation hyperventilation
• NGT and charcoal
• Serial cardiac monitoring
• Exclusion of other co-ingestions
• Admitted to ICU for ongoing care

 

ECG Features and Management of TCA Toxicity

 

Check out the following posts from Life in the Fast Lane for more information:

• Sodium Channel Blocker Toxicity
• Toxicology Conundrum - Another TCA overdose
• Toxicology Conundrum - TCA Toxicity

 

References / Further Reading

 

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.