ECG Changes on Poisoning / Intoxication

 ECG changes on poisoning/ intoxication

 

ECG	Substance	Date	Origin
Asystole	Lithium	1991	UK[1]
First degree AV block	Carbon monoxide Lithium	2013 2018	Riyadh[2] Taiwan[3] Kaohsiung Medical University Hospital
QRS complex widening	Hydrofluoric acid tricyclic antidepressant	2005 2016	USA [4] New Orleans[5] Spain [6]
QT interval prolongation	Hydrofluoric acid organophosphate	2005 2009	USA [4] Iran [7]
R wave in aVR ≥ 3 mm		2012	Spain [6]
Scooping of the T waves	Digoxin	2017	Lebanon[8]
Sinus bradycardia	Calcium channel blockade Beta-adrenergic receptor blockade
Sinus Dysfunction	Lithium	1995	Japan [9]
Tall T wave	Hydrofluoric acid	2001	Taiwan [10] MacKay Memorial Hospital.

 

References

1.      Ong AC, Handler CE. Sinus arrest and asystole due to severe lithium intoxication. Int J Cardiol. 1991 Mar;30(3):364-6. doi: 10.1016/0167-5273(91)90021-g. PMID: 2055679.

2.      Salih SB, Alenezi H, Alghamdi A. A case of first degree AV block in carbon monoxide poisoning patient. J Saudi Heart Assoc. 2013 Oct;25(4):255-9. doi: 10.1016/j.jsha.2013.05.004. PMID: 24198450; PMCID: PMC3818633.

3.      Chien SC, Liu KT, Wu YH. Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report. Medicine (Baltimore). 2018 Nov;97(45):e13129. doi: 10.1097/MD.0000000000013129. PMID: 30407335; PMCID: PMC6250446.

 

4.      Holstege C, Baer A, Brady WJ. The electrocardiographic toxidrome: the ECG presentation of hydrofluoric acid ingestion. Am J Emerg Med. 2005 Mar;23(2):171-6. doi: 10.1016/j.ajem.2004.04.032. PMID: 15765339.

5.      Glancy DL. ECG Of the Month: Suicide. J La State Med Soc. 2016 Mar-Apr;168(2):66-7. Epub 2016 Apr 15. PMID: 27383860.

6.      Yates C, Manini AF. Utility of the electrocardiogram in drug overdose and poisoning: theoretical considerations and clinical implications. Curr Cardiol Rev. 2012 May;8(2):137-51. doi: 10.2174/157340312801784961. PMID: 22708912; PMCID: PMC3406273.

7.      Shadnia S, Okazi A, Akhlaghi N, Sasanian G, Abdollahi M. Prognostic value of long QT interval in acute and severe organophosphate poisoning. J Med Toxicol. 2009 Dec;5(4):196-9. doi: 10.1007/BF03178266. PMID: 19876851; PMCID: PMC3550412.

8.      Mansour MJ, Kalaoui M, Chammas E, Hamoui O, Fawaz T, AlJaroudi WA. Unusual digoxin toxicity with myocardial injury. J Electrocardiol. 2017 Nov-Dec;50(6):909-911. doi: 10.1016/j.jelectrocard.2017.07.013. Epub 2017 Jul 12. PMID: 28807352.

9.      Nakamura H, Takahashi F, Matsuzaka T, Tanaka H, Akashi N, Sato N, Kikuchi K. [A case of lithium induced sinus mode dysfunction]. Nihon Naika Gakkai Zasshi. 1995 Jan 10;84(1):127-9. Japanese. PMID: 7722356.

10.  Su YJ, Lu LH, Choi WM, Chang KS. Survival after a massive hydrofluoric acid ingestion with ECG changes. Am J Emerg Med. 2001 Sep;19(5):458-60. doi: 10.1053/ajem.2001.24503.

edited by Yu-Jang Su