Electrocardiographical case. A man found unconscious

Tan C, Pillai S, Manning PG
Correspondence: Dr Camlyn Tan, camlyn_tan@cgh.com.sg

ABSTRACT
A 25-year-old man was brought to the emergency room after being found unconscious. Electrocardiography (ECG) showed changes classical of tricyclic antidepressant (TCA) poisoning. These included sinus tachycardia, QTc prolongation, QRS complex widening, right axis deviation and positive R waves in lead aVR. This unique ECG highlights the importance of lead aVR, which often tends to be ignored. Treatment is started based on ECG findings.

Keywords: electrocardiogram, poisoning, sodium bicarbonate, tricyclic antidepressants
Singapore Med J 2006; 47(8): 730-735