Wide QRS tachycardia in a young woman with a drug overdose
D. Luke Glancy, MD, and Cynthia F. Glancy, MN
A depressed young woman attempted suicide by taking approximately 2 g of nortriptyline. She had multiple seizures, a systolic blood pressure of 50 mm Hg, and a respiratory arrest and was comatose when brought by ambulance to the emergency department, where she was immediately intubated. The electrocardiogram recorded on admission shows a minimally irregular wide-QRS tachycardia with a long QT interval (heart rate, 104 beats/minute; QRS duration, 0.20 seconds; QTc interval, 0.52 seconds) that could be ventricular tachycardia but is probably sinus tachycardia with right bundle branch block and a northwest QRS axis (Figure 1).
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