Brugada Pattern: An Unusual Presentation of Tricyclic Antidepressant Overdose

Otero, Diana; Lopez, Persio; Calderon, Eder Hans Cativo; Kiss, Joshua E.; Liao, Steve

doi:10.1016/s0735-1097(19)33272-3

Cited by 1 publication

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In some of the cases, there was no evidence of preexisting BrS. 28,30,31 However, with others, it was difficult to tell whether the antidepressant precipitated the ECG pattern or unmasked an existing BrS. 39 A baseline ECG may have clarified this.…”

Section: Tricyclic Antidepressantsmentioning

confidence: 99%

“… 21 , 22 Alongside supportive management of the patient, sodium bicarbonate IV has demonstrated efficacy when used to promote the recovery of a ‘normal’ ECG pattern. 28 – 31 Any fever should be reduced immediately; paracetamol can be prescribed for this. 21 Isoproterenol, a non-selective β adrenoceptor agonist, has been found to be effective and is a drug of choice for the acute treatment of Brugada, particularly in the context of electrical storm as further outlined below.…”

Section: Medication Used To Treat Brugadamentioning

confidence: 99%

“… 28 – 31 , 38 – 40 For example, intoxication with drugs that inhibit cardiac sodium channels, such as tricyclic antidepressants, can trigger BrP in otherwise normal individuals. 31 Differentiating between the two is challenging but important in informing the patient’s future care plan.…”

Section: Psychotropic Medications Associated With Brugadamentioning

confidence: 99%

“…This section will review case reports that specifically mention the BrS. 28 – 31 , 38 – 40 Please see Table 2 for further details of the cases.…”

Section: Tricyclic Antidepressantsmentioning

confidence: 99%

“…37 In some of the cases reviewed in this article, a particular psychotropic medicine unmasked BrS while in others may have precipitated BrP. [28][29][30][31][38][39][40] For example, intoxication with drugs that inhibit cardiac sodium channels, such as tricyclic antidepressants, can trigger BrP in otherwise normal individuals. 31 Differentiating between the two is challenging but important in informing the patient's future care plan.…”

Section: Psychotropic Medications Associated With Brugadamentioning

confidence: 99%

See 4 more Smart Citations

Brugada syndrome: should we be screening patients before prescribing psychotropic medication?

Attard

Stanniland

Attard

et al. 2022

Therapeutic Advances in Psychopharmacology

View full text Add to dashboard Cite

Brugada syndrome (BrS) presents with a characteristic electrocardiogram (ECG) and is associated with sudden cardiac death. Until now, prolongation of QTc interval and its association with Torsade de Pointe and possible fatal arrhythmia have been the focus of routine baseline ECGs before prescribing psychotropic medication. A semi-systematic literature review was conducted using PubMed. The terms ‘Brugada’, ‘Brugada Syndrome’ AND ‘psychotropic’ ‘antipsychotic’ ‘antidepressant’ ‘mood stabilisers’ ‘clozapine’ ‘Tricyclic Antidepressants’ ‘Lithium’ were searched. From a search that delivered over 200 articles, 82 articles were included. Those that included details around causative medication, doses of medication and where clear timeline on drug cause were included. Where clarification was needed, the manufacturer of the medication was contacted directly. Psychotropic medication can be associated with BrS, Brugada phenocopy or unmasking of BrS, in overdose or in normal doses. Our results include a table summarising a number of psychotropic overdoses that led to BrS unmasking. Routine screening for BrS in patients before prescribing psychotropic medication is a natural extension of the baseline ECG currently routinely done to rule out QTc prolongation. Psychiatrists need to invest in ensuring better skills in interpreting ECGs and work closer with cardiologists in interpreting ECGs.

show abstract

Section: Tricyclic Antidepressantsmentioning

confidence: 99%