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Paper Information

Title: 

ASSESING OF R VARIATION FROM AVR IN PREDICTING CARDIAC WITH RESPECT TO WIDENNING OF QRS AND CNS TOXICITY OF TRCYCLIC ANTIDEPRESSANTS (TCAS)

Type: SPEECH
Author(s): IZADI MOUD N.,GHESHLAGHI F.,MONTAZERI K.
 
 
 
Name of Seminar: IRANIAN CONGRESS OF TOXICOLOGY
Type of Seminar:  CONGRESS
Sponsor:  SOCIETY OF TOXICOLOGY
Date:  2004Volume 8
 
 
Abstract: 

Trcyclic antidepressants (TCAS) Poisoning is one of the most common poisoning in Poisoning Emergency Department, Noor Hospital, Isfahan, Iran. With respect to the severe cardiovascular and central nervous system complications associated with TCAs toxicity and great number of poisoned patients with TCAs in our department, precise investigation was done. The objective of this study was to compare QRS interval duration with RaVR³ 3mm and R/SaVR³ 0.7 in predicting serious complications of acute TCA toxicity. This study was descriptive – analytic and prospective cohort. One hundred and fifty five TCA Poisoned Patients were evaluated in the Poisoning Emergency Department of Noor Hospital, Isfahan, Iran from March 2002 to March 2003. On admission time, after clinical evaluation, ECG and ABG were performed for patients. The data was analysed by SPSS software, using t – students, chi- square tests.
Most patients were 11-30 year olds (78.1%). The women (60%) and most of them married (55%).The ECG results showed that RaVR
³3mm , R/SaVR³ 0.7 , QRS³0.1(s), QT> 0.48(s) , Right axis deviation and arrhythmia were 5.2%, 12.9%, 37.4%, 8.38% , 12.4% and 4.5 % respectively .The incidence of non –cardiac complications were as follows: Loss of consciousness (85.5%) , Acidosis (65%) , Mucus membranes dryness (55.6%) and Midriasis (25.2%).There was a significant relationship between widening QRS with arrhythmia , RaVR³3mm with tachycardia and delirium , and R/SaVR³ 0.7 with delirium , seizure , tachycardia , hypotention and arrhythmia. There was also a significant relationship between Prolonged QT (QT>0.48(s)) with seizure and agitation. A rightward deviation of the vector of the QRS Complex between 130° and 270° was related to arrhythmia. QRS interval duration (61.5% -85.7%) was found to be a more sensitive indicator of toxicity than the R/SaVR ³ 0.7 (27.1% -30.7%) and RaVR>3mm (7.6% -14.2%).The positive Productive Values (PPV) of ECG parameters for TCA toxicity for R/SaVR ³0.7 (20%) was more than RaVR³3mm (12.5%) and widening QRS (10.3%).
Specific ECG measurments such as R/SaVR, QRS interval duration and height of the R wave in lead aVR can be useful Parameters in assessing and predicting cardiac and CNS of TCA toxicity.

 
Keyword(s): TRICYCLIC ANTIDEPRESSANTS, WIDENING QRS, POISONING, RAVR MODIFICATIONS (RAVR³3MM, R/SAVR³ 0
 
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