Amitriptyline poisoning: wide-complex tachycardia
After a medication ingestion
A 25-year-old man is found unconscious by his family. Empty amitriptyline packs are brought to the emergency department. This is the published initial ECG.
The photograph is slightly oblique; quoted numerical measurements come from the authors.
Look for
- Wide-complex tachycardia.
- QRS >160 ms reported by the authors; not independently remeasured from this photograph.
- Positive terminal deflection in aVR.
Where to look. Inspect QRS width across several leads, then the terminal portion in aVR. This photograph is not suitable for precise pixel measurements.
Sodium-channel blockade slows the spread of ventricular activation and widens the QRS. A positive terminal deflection in aVR adds support. Interpret the ECG alongside the exposure history.
The published case documents severe amitriptyline poisoning. The question targets the ECG component of objective 12.2 without asking learners to reconstruct the ingested dose or treatment.
References & provenance
Hampton & Hampton, The ECG Made Easy, 9e (2019), ch. 2, pages du PDF 42–43; Hampton & Adlam, The ECG Made Practical, 7e (2019), ch. 1, p. 27; Lilly (dir.), Pathophysiology of Heart Disease, 6e (2016), ch. 17, p. 424–426 (pages du PDF 435–437 : mécanisme général du blocage sodique).
Wakoya AD, Asenabeto TG, Moti HD, et al. Survival after multiple in-hospital cardiac arrests due to severe amitriptyline poisoning– a case report. International Journal of Emergency Medicine 19, 4 (2026). doi:10.1186/s12245-025-01109-6. Figure 1. CC BY 4.0. CC BY 4.0
Adaptation: cropping and removal of headers/annotations outside the tracing where applicable; metadata removed. Waveforms have not been redrawn.
Compared with the published source; no independent clinical validation is claimed.
Original annotations & limitations
Initial ECG: wide complex tachycardia, QRS duration >160 ms, terminal R wave in aVR (source caption paraphrased).
Published case: 25-year-old man found unconscious by family; empty amitriptyline packs brought to the emergency department. Initial ECG described as wide-complex tachycardia with QRS >160 ms and a terminal R wave in aVR.
Published ECG photograph is oblique; numeric QRS duration is source-reported. The question does not require a new exact measurement or independent confirmation of the tachycardia mechanism.