title: Survival after severe amitriptyline poisoning with prolonged ventricular tachycardia and cardiac arrest.
abstract: BACKGROUND
  Tricyclic antidepressants (TCA) are becoming one of the most frequently used substances in self poisoning. Significant morbidity and mortality associated with TCA overdose are often related to and refractory hypotension. We report the first case of survival after severe amitriptyline poisoning, leading to prolonged cardiac arrest and ventricular tachycardia (VT), resuscitated with 3 h of uninterrupted cardiac massage and Direct current (DC) shocks.
  
  
  METHODS
  A 25 year old girl presented with severe amitriptyline poisoning causing pulseless VT and prolonged cardiac arrest. After 3 h of uninterrupted external cardiac massage, together with nine DC shocks and intra venous bicarbonate injections the rhythm reverted to a nodal tachycardia, initial 2D echocardiogram showed left ventricular dysfunction, which recovered to normal after 2 weeks and the patient had a complete recovery subsequently.
  
  
  CONCLUSIONS
  Our case highlights the importance of continued resuscitation in patients presenting with TCA poisoning and resistant arrhythmia, especially in young and otherwise healthy patients.
authors.affiliation: Professorial Medical Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka. dayakshi@yahoo.com.
authors.forename: Dayakshi D K
authors.initials: DD
authors.lastname: Abeyaratne
authors.affiliation: Professorial Medical Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka.
authors.forename: Chathuri
authors.initials: C
authors.lastname: Liyanapathirana
authors.affiliation: Professorial Medical Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka.
authors.forename: Anushka
authors.initials: A
authors.lastname: Gamage
authors.affiliation: Professorial Medical Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka.
authors.forename: Piyumanthi
authors.initials: P
authors.lastname: Karunarathne
authors.affiliation: Professorial Medical Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka.
authors.forename: Medhini
authors.initials: M
authors.lastname: Botheju
authors.affiliation: Professorial Medical Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka.|Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
authors.forename: Jegarajah
authors.initials: J
authors.lastname: Indrakumar
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000506:poisoning*; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D011654:Pulmonary Edema / Q000150:complications / Q000000981:diagnostic imaging; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000000981:diagnostic imaging
chemical_list: D000639:Amitriptyline
keywords: Cardiac arrhythmia; Prolonged cardiac arrest; Tricyclic antidepressants