Myocardial infarction: a rare complication of dothiepin overdose

Arya, Basant; Hirudayaraj, Purnima; Willmer, Katherine A.

doi:10.1016/j.ijcard.2003.06.017

Cited by 7 publications

(7 citation statements)

References 6 publications

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“…The authors suggested that the changes were caused by either the quinidine‐like activity of dothiepin or by an alteration in membrane permeability allowing differences in potassium concentrations between different areas of the myocardium, rather than by any myocardial ischaemic damage. Arya et al (2004) also reported ST segment elevation in leads V2 and V3 and T‐wave inversion in leads V4, V5 and V6 suggestive of acute myocardial infarction after overdose of dothiepin. ECG changes persisted for 4 weeks.…”

Section: Discussionmentioning

confidence: 83%

Acute Myocardial Infarction Associated with Amitriptyline Overdose

Kıyan

Aksay

Yanturali

et al. 2006

Basic Clin Pharma Tox

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Tricyclic antidepressant overdose is known to cause cardiopulmonary and central nervous system complications. As with other cardiovascular complications, amitriptyline toxicity may cause acute myocardial infarction. This paper reports the case of a young female with acute myocardial infarction as a novel consequence of tricyclic antidepressant overdose.Tricyclic antidepressant overdose is the one of the most common in self-poisoning. Tricyclic antidepressants account for the third largest number of deaths reported to American poison control centres. Amitriptyline is the most common single agent (Watson et al. 2005). The high rate of mortality in tricyclic antidepressant overdosing is due to central nervous system and cardiovascular system toxicity. Evidence of cardiovascular toxicity is present in the majority of tricyclic antidepressant overdoses. Cardiotoxicity is hypotension, QRS widening and ventricular arrhythmias (Smilkstein 1990). Transient electrocardiographic changes and cardiac arrhythmias are well-documented complications of tricyclic antidepressant overdose, however acute myocardial infarction has only been rarely reported. Here we report a case of tricyclic antidepressant overdose, followed by acute myocardial infarction. Materials and MethodsCase report. A 33 year old female was referred to Emergency Department after ingestion of 30 tablets (300 mg) of amitriptyline for suicidal purpose. She was admitted to state hospital 4 hr after ingestion, and because of decreased level of consciousness (Glasgow coma score 3) she had been intubated with nasogastric tube administered, 50 g of activated charcoal and the finally referred to the Emergency Departments.Her past medical history was major depression, and she had been heated with amitriptyline for five years. She had no coronary artery risk factors such as a diabetes, hypertension, hyperlipidaemia, smoking and no family history of heart disease. Her blood pressure was 110/70 mmHg, heart rate was 120 beats/min., and pulse oxymetre with artificial ventilation was 100% on admission. Her oral mucous membrane was dry, and bowel sounds werediminished. Her pupils reacted to light and no neurological signs were found. The rest of physical examination was also normal. Her initial ECG revealed sinus tachycardia, QRS widening (120 msec.) and QTc interval prolongation (521 msec.) ( fig. 1). Initial complete blood count and serum electrolytes were normal. Arterial blood gas examination Author for corresponcence: Selahattin Kiyan, Ege University Hospital, Department of Emergency Medicine, 35100, Bornova, Izmir, Turkey (fax π90 232 388 38 05, e-mail selahattin.kiyan/ege.edu.tr). revealed respiratory alkalosis (pH: 7.55, PaCO2: 24.9 mmHg, PaO2: 99.3 mmHg, BE: 1.7 mmol/l). D Dimer 0.4 mg/ml (0-0.5 mg/ml) was normal. Toxicological screen cocaine, amphetamine, opiates and heroin was negative. In our institution, amitriptyline level could not be measured. The patient was extubated 26 hr after ingestion. She denied any drug ingestion other than amitriptyline after...

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Section: Discussionmentioning

confidence: 83%

Acute Myocardial Infarction Associated with Amitriptyline Overdose

Kıyan

Aksay

Yanturali

et al. 2006

Basic Clin Pharma Tox

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“…Limited data suggest that extramarital coitus is more dangerous than marital ones [53]. Extremely rare are cases of myocardial infarction following sympathomimetic stimulation accompanying an antidepressant dothiepin overdose [54].…”

Section: "Sympathetic" External Triggersmentioning

confidence: 99%

Acute risk factors for myocardial infarction

Čulić

2007

International Journal of Cardiology

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“…No coronary angiography was obtained because of normal myocardial perfusion at the single photon emission tomography. Similarly, Arya et al described a case of dothiepin overdose complicated by a typical electrocardiographic feature of acute myocardial infraction [16]. No data were available regarding cardiac markers.…”

Section: Discussionmentioning

confidence: 99%

Tako-tsubo syndrome following nortriptyline overdose

Roock

Beauloye

Bauwer

et al. 2008

Clinical Toxicology

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Background. Tako-tsubo syndrome (TTS) refers to the apical ballooning of the left ventricle observed when angiographic ventriculography is performed in patients presenting with electrocardiographic changes suggestive of acute coronary syndrome (new transient ST-segment deviation (>0.05 mV) or T-wave inversion (>0.2 mV)), mild elevation of cardiac markers, but normal coronary arteries at the angiogram. Case report. A 54-year-old woman developed the characteristic features of TTS 44 hours following nortriptyline overdose. The admission ECG showed increased QRS duration rapidly reversible after sodium bicarbonate infusion. There was a minimal increase in troponin I level. The ECG performed at the time of chest pain revealed deeply negative T waves in leads I, II, III, aVF, V1 to V6 and remained abnormal at 5 weeks follow-up. In contrast, a complete recovery of left ventricular function was observed within one week. Discussion. The pathophysiology of TTS, a variant of myocardial stunning, is still incompletely understood but could be related to sympathetic overstimulation. The possibility of TTS following toxic exposure is discussed.

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Myocardial infarction: a rare complication of dothiepin overdose

Cited by 7 publications

References 6 publications

Acute Myocardial Infarction Associated with Amitriptyline Overdose

Acute Myocardial Infarction Associated with Amitriptyline Overdose

Acute risk factors for myocardial infarction

Tako-tsubo syndrome following nortriptyline overdose

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