[Electrocardiographic changes that wrongly indicate severe myocardial ischemia in patients treated with antidepressive drugs].
The paper reports the case of a female 54-years old admitted to UTIC following recent episodes of precordial pain associated with major ECG alterations (negative T wave in precordial derivations) which appeared to indicate ischemic damage. The normality of laboratory tests and the mechanical function of the left ventricle studied using echo-Doppler raised doubts regarding the diagnosis of ischemic cardiopathy. After an interval of 2 months (during which the patient was constantly asymptomatic), owing to the persistence of ECG alterations during the recovery stage, an effort test was performed using thallium; the latter was normal and thus enabled the ischemic genesis of these alterations to be excluded. The suspension of antidepressive therapy with tricyclic agents, which the patient had taken for years, was followed after a few months by the stabilisation of ECG. This confirms that tricyclic antidepressive agents may significantly interfere with the electric activity of the myocardial cells, provoking considerable difficulties for a correct diagnosis.
Minutiello
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Regione Marche-Azienda Sanitaria n. 2 Ospedale di Urbino, Reparto di Cardiologia.
D000639:Amitriptyline / Q000009:adverse effects; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D003951:Diagnostic Errors; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000187:drug effects*; D006801:Humans; D007099:Imipramine / Q000009:adverse effects; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic; D013997:Time Factors
D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline; D007099:Imipramine
Alterazioni elettrocardiografiche falsamente indicative di severa ischemia miocardica in paziente in trattamento con farmaci antidepressivi.