title: ST-T segment changes in patients with tricyclic antidepressant poisoning.
abstract: OBJECTIVE
  Tricyclic antidepressant (TCA) poisoning is among highly prevalent and potentially dangerous toxicities. ST-T changes are observed in the electrocardiogram (ECG) of most of TCA poisoned patients. We aimed to study ST-T segment changes in TCA toxicity and its probable relationship with other ECG findings.
  
  
  METHODS
  This retrospective study was carried out in Noor and Ali Asghar University Hospital, Isfahan (Iran) in 2012. Patients with TCA toxicity based on the patients' history who had not consumed any cardio-active drugs and did not have a past medical history of cardiovascular disease in the recent 5 years, were randomly selected and investigated. Their demographic and medical data on admission including ECG, age, sex, type and amount of ingested TCA, poisoning severity score, QRS changes, QT interval, heart axis position and R-wave were all recorded. ST-T changes and their relation with other ECG parameters have been determined using statistical analysis.
  
  
  RESULTS
  Medical records of 272 patients were analyzed. In symptomatic patients, ST change prevalence was 40.8% and T change prevalence was 9.5%. In asymptomatic patients, the frequency of ST and T changes were 4.8% and 0.8%, respectively (P < 0.05). The most common ST and T changes in baseline (on admission) ECG were non-significant elevation (15.4%), significant elevation (11%) in pre-cordial leads, and T-wave flattening (6.6%). A statistically significant correlation was documented between ST segment changes with QRS and R-wave in aVR. The correlation between T-wave changes and R-wave in aVR lead was also significant.
  
  
  CONCLUSIONS
  ST-T changes in TCA poisoned patients are more prevalent in symptomatic patients. Obviously for a more definite conclusion, it is necessary to design a prospective study with the control group. This may facilitate a better understanding of ST-T segment changes.
authors.affiliation: Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Farzad
authors.initials: F
authors.lastname: Gheshlaghi
authors.affiliation: Department of Toxicology, Noor General University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mozhgan Karbalayi
authors.initials: MK
authors.lastname: Mehrizi
authors.affiliation: Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Yaraghi
authors.affiliation: Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ali Mohammad
authors.initials: AM
authors.lastname: Sabzghabaee
authors.affiliation: Department of Pulmonary, Shahrekord University of Medical Sciences, Shahrekord, Iran.
authors.forename: Forough
authors.initials: F
authors.lastname: Soltaninejad
authors.affiliation: Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Nastaran
authors.initials: N
authors.lastname: Eizadi-Mood
keywords: Electrocardiogram; poisoning; toxicity; tricyclic antidepressant