Assistant professor of emergency medicine,Alborz University of Medical Sciences, Karaj, Iran
General physician,Kermanshah University of Medical Sciences, Kermanshah, Iran
Of all antidepressants, tricyclic antidepressants (TCAs) are the most toxic drugs and they are often used for suicide attempts. An 18-year-old female was admitted to the emergency department after having taken 30 tablets of Nortriptyline 50 mg in a suicide attempt. A twelve-lead electrocardiogram revealed right bundle branch block in leads V1, V2, and V3 as well as deep S in leads, V5, and V6, and tall R in AVR, which meant extreme right axis and ST elevation in leads V2 and V3: that raised the suspicion of the Brugada syndrome. ST elevation after TCA toxicity is a rare medical condition, and our literature review failed to find any relevant reports.