www.congestive heart failure symptom.medgrip.com
Hello!
Thank you for visiting congestive heart failure symptom website.
Let me briefly introduce myself. My name is Sergey. I am 44 years old. In a fall of 2005 I was diagnosed
with congestive heart failure symptom. My strong believe that it happened because I was on tryciclic
antidepressant nortriptyline (100mg. Daily) for 2 years. This site is my attempt to put together my research
about adverse effects of nortriptyline in general, heart-damaging effects in particular. If you have
unfortunate experience dealing with nortriptyline and would like to share your knowledge with others
please Email to webmaster@medgrip.com.
Hank you once again for visiting congestive heart failure symptom website
Internet research.
http://www.mentalhealth.com/drug/p30-a05.html
Patients with cardiovascular disease should be given nortriptyline only under close
supervision because of the tendency of the drug to produce sinus tachycardia and to
prolong the conduction time.
Both elevation and lowering of blood sugar levels have been reported.
http://www.mentalhealth.com/drug/p30-a05.html
Adverse Effects
Note:
Included in the following list are a few adverse reactions that have not been reported with this specific
drug. However, the pharmacologic similarities among the tricyclic antidepressant drugs require that each of
these reactions be considered when nortriptyline is administered.
Cardiovascular:
Hypotension, hypertension, tachycardia, palpitation, myocardial infarction, arrhythmias, heart block,
stroke.
Overdose
Symptoms:
Overdose of tricyclic antidepressants may be manifest with doses as small as 50 mg in a child. Of patients
who are alive at initial presentation, a mortality rate of between 0% and 15% has been reported. Symptoms
of overdose of tricyclic antidepressants may begin within several hours of oral ingestion. Symptoms and
signs may include blurred vision, confusion, restlessness, dizziness, hypothermia, hyperthermia, agitation,
vomiting, hyperactive reflexes, dilated pupils, fever, rapid heart rate, decreased bowel sounds, dry mouth,
inability to void, myoclonic jerks, seizures, respiratory depression, myoglobinuric renal failure, nystagmus,
ataxia, dysarthria, choreoathetosis, coma, hypotension, and cardiac arrhythmias. An effect on cardiac
conduction similar to that of quinidine may be seen with slowing of conduction, prolongation of the QRS
complex and QT intervals, right bundle branch and AV block, ventricular tachyarrhythmias (including
Torsade de pointes and fibrillation), and death. Prolongation of the QRS duration to more than 0.1 seconds
is predictive of more severe toxicity. The absence of sinus tachycardia does not ensure a benign course.
Hypotension may be caused by vasodilation, central and peripheral alpha-adrenergic blockade, and cardiac
depression. In a healthy young person, prolonged resuscitation may be effective; one patient was reported
to survive 5 hours of cardiac massage.
http://www.emedicine.com/med/topic2367.htm
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=163
90222&itool=iconabstr&query_hl=2&itool=pubmed_docsum
Tricyclic antidepressant poisoning : cardiovascular toxicity.
Thanacoody HK, Thomas SH.
Wolfson Unit of Clinical Pharmacology, School of Clinical and Laboratory Sciences, University of
Newcastle, and National Poisons Information Service (Newcastle Centre), Newcastle upon Tyne, UK.
Tricyclic antidepressants remain a common cause of fatal drug poisoning as a result of their cardiovascular
toxicity manifested by ECG abnormalities, arrhythmias and hypotension. Dosulepin and amitriptyline
appear to be particularly toxic in overdose. The principal mechanism of toxicity is cardiac sodium channel
blockade, which increases the duration of the cardiac action potential and refractory period and delays
atrioventricular conduction. Electrocardiographic changes include prolongation of the PR, QRS and QT
intervals, nonspecific ST segment and T wave changes, atrioventricular block, right axis deviation of the
terminal 40 ms vector of the QRS complex in the frontal plane (T 40 ms axis) and the Brugada pattern
(downsloping ST segment elevation in leads V1-V3 in association with right bundle branch block).
Maximal changes in the QRS duration and the T 40 ms axis are usually present within 12 hours of ingestion
but may take up to a week to resolve. Sinus tachycardia is the most common arrhythmia due to
anticholinergic activity and inhibition of norepinephrine uptake by tricyclic antidepressants but
bradyarrhythmias (due to atrioventricular block) and tachyarrhythmias (supraventricular and ventricular)
may occur. Torsade de pointes occurs uncommonly. Hypotension results from a combination of reduced
myocardial contractility and reduced systemic vascular resistance due to alpha-adrenergic blockade. Lifethreatening arrhythmias and death due to tricyclic antidepressant poisoning usually occurs within 24 hours
of ingestion. Rapid deterioration is common. Level of consciousness at presentation is the most sensitive
clinical predictor of serious complications. Although a QRS duration >100 ms and a rightward T 40 ms
axis appear to be better predictors of cardiovascular toxicity than the plasma tricyclic drug concentration,
they have at best moderate sensitivity and specificity for predicting complications.
http://www.medscape.com/medline/abstract/12608134
[Reversible cardiomyopathy induced by psychotropic drugs: case report and
literature overview]
Ann Cardiol Angeiol (Paris). 2002; 51(6):386-90 (ISSN: 0003-3928) Cruchaudet B; Eicher JC; Sgro C;
Wolf JE
Centre de cardiologie clinique et interventionnelle, hôpital du Bocage, CHU Dijon, 2, boulevard Maréchalde-Lattre-de-Tassigny, 21034 Dijon, France. jean-christophe.eicher@chu-dijon.fr
A number of psychotropic drugs, including tricyclic antidepressants, phenothiazine and lithium, have a well
demonstrated risk of cardiotoxicity. Each individual therapeutic class has potentially deleterious effects on
electrophysiology and myocardial function. The authors report a case showing how serious side effects may
result from the association of these different classes in the presence of a coexistent heart disease, even
when the underlying disease is mild.
Psychotropic medication and the heart
Patrick O’Brien and Femi Oyebode
http://apt.rcpsych.org/cgi/content/full/9/6/414
The cardiotoxicity and mortality from overdose of tricyclic antidepressants is well established. Toxicity
arises from sodium (Na+) ion-channel blockade, known as Type 1 antiarrhythmic action. This reduces
inward Na+ depolarising current at the beginning of the action potential, leading to conduction delay,
bradycardia, atrioventricular block, bundle branch block and monomorphic ventricular tachycardia.
http://www.emedicine.com/ped/topic2714.htm
Toxicity, Tricyclic Antidepressant (TCA)
Last Updated: August 2, 2004
Medical/Legal Pitfalls:
 Failure to recognize new onset of ventricular arrhythmia as a direct consequence of TCA overdose
 Failure to appreciate the potential for rapid deterioration in a patient with TCA overdose
 Failure to manage the airway properly during decontamination
 Failure to administer sodium bicarbonate in a timely fashion
http://www.emedicine.com/emerg/topic37.htm
Toxicity, Antidepressant
Last Updated: January 5, 2006
Frequency:
 In the US: According to the Toxic Exposure Surveillance System (TESS) data from the American
Association of Poison Control Centers (AAPC), 12,710 cyclic antidepressant exposures were
reported in 2003. Amitriptyline accounted for most exposures with 7,309 (58%). Of all TCA
exposures, 7,835 (62%) were intentional overdoses, 9,622 (76%) were treated at a health care
facility, 1,373 (11%) resulted in major toxicity, and 93 (0.007%) resulted in death. In 1998, 15,710
cyclic antidepressant exposures were reported in the United States; of these exposures, 1694
(11%) resulted in major toxicity and 88 (0.6%) resulted in fatality. Most exposures were
intentional and required treatment in a health care facility.
TCA use has declined in relation to the newer, less toxic, selective serotonin reuptake inhibitor
(SSRI) antidepressants, but TCAs remain widely prescribed and are among the most commonly
reported drugs associated with overdose. TCAs are used for depression but also are prescribed for
nontraditional uses (eg, chronic pain syndromes, migraine prophylaxis, peripheral neuropathies).
http://www.freerepublic.com/forum/a38fdc122664b.htm
Boy apparently dies from longterm ritalin use.
As of 1993, there had been 4 sudden deaths associated with Norpramin (desipramine), a member of the
family of tricyclic antidepressants (TCAs) and a common alternative to Ritalin, in the treatment of ADHD.
In 1995, Werry, of New Zealand, called for an embargo of desipramine in children, but was shouted down
by Biederman, et al, of the Harvard-Massachusetts General Hospital, Pediatric Psychopharmacology
Group. To date, desipramine- and other TCA-related, sudden, cardiac deaths have risen to 16, most of them
in normal children said by school teachers, to have ADHD.
http://www.theannals.com/cgi/content/abstract/35/7/862
Sudden cardiac death with clozapine and sertraline
combination
JD Hoehns, MM Fouts, MW Kelly, and KB Tu
OBJECTIVE: To report a case of sudden cardiac death in a patient receiving combination therapy with
clozapine and sertraline. CASE SUMMARY: A 26-year-old white man was discovered dead at his
residence. His medical history included chronic paranoid schizophrenia, obsessive-compulsive disorder,
major depressive disorder, obstructive sleep apnea, and akathisia. He had no prior history of cardiovascular
disease. His medication regimen included clozapine 100 mg twice daily (started 4 y prior to his death),
risperidone 3 mg twice daily, sertraline 200 mg once daily, atenolol 50 mg twice daily, and lorazepam 0.5
mg four times daily. Autopsy and toxicology studies revealed cardiomegaly suggestive of idiopathic
cardiomyopathy, single-vessel coronary artery disease, sertraline and clozapine blood concentrations in the
expected range, undetectable lorazepam and risperidone blood concentrations, obesity, and moderate fatty
changes to the liver. The most likely cause of death was sudden cardiac death due to acute cardiac
arrhythmia. DISCUSSION: Clozapine is structurally similar to the tricyclic antidepressants, which
have type 1 A antiarrhythmic properties. Case reports have described electrocardiographic abnomalities,
cardiomyopathy, and fatal myocarditis associated with its use. Unexplained death in patients on clozapine
therapy has also been reported. Sertraline appears to have less cardiac effect; however, one report has
observed clinically significant QT prolongation during sertraline therapy. CONCLUSIONS: Clozapineinduced cardiomyopathy and cardiac arrhythmia from clozapine and/or sertraline use may have contributed
to this man's death.
---------------------------------------------------------------------------------------------------------http://home.blarg.net/~charlatn%20/depression/tricyclic.faq.html
Cardiovascular effects are also associated with these medications. Orthostatic hypotension, i.e. dizziness
upon arising or otherwise rapidly changing posture, is common. A rapid heartbeat is often reported,
sometimes with palpitations. The medications can have deleterious effects on an unhealthy heart, e.g.
causing EKG (electrocardiogram) changes or arrhythmias (disturbances in cardiac rhythm or conduction);
or, rarely, worsening or precipitating angina or heart failure or precipitating a myocardial infarction (heart
attack). These cardiac effects may eliminate the tricyclics from consideration for some patients, although
with close ongoing monitoring they may often be employed to good effect. A thorough evaluation of their
safety in the presence of reported history of cardiac disease, especially a cardiac conduction defect, is
always warranted and may involve a referral for a consultation with a cardiologist. In all patients from
middle adulthood, it is prudent to obtain an EKG prior to treatment and with dosage increases beyond a
certain extent.
Tricyclic antidepressants are now the leading cause of death by drug overdose in the United States.
http://www.chiro.org/nutrition/ABSTRACTS/Nutrient_Depletion_Checklist_Psychotherapeutic.shtml
Tricyclic Antidepressants
Amitriptyline (Elavil), desipramine (Norpramin, Petrofrane), nortriptyline Aventyl, Pamelor), doxepin
(Adapin, Sinequan, Zonalon) imipramine (Janimine, Tofranil)
Coenzyme Q10
Congestive heart failure, high blood pressure, low energy
Vitamin B2
Problems with eyes, mucous membranes, nerves, skin
http://www.diabetic-help.com/Trycyclic%20Antidepressants
What are the preliminaries to starting on a tricyclic? A thorough medical screening including bloodwork is
required to be sure that a medical illness is not being mistaken for the psychiatric diagnosis. It is crucial as
well to determine whether you have the types of cardiac conduction disease which would make the use of a
tricyclic dangerous. These can be detected with an EKG, which should be a routine precursor to beginning
on a tricyclic for patients over 40 years of age or anyone with a history of heart disease. When doubts about
the safety of these drugs arise, a cardiology consultation is prudent.
http://mainegov-images.informe.org/ag/drugreport.pdf
maine drug related mortality patterns ( mentioned aventyl)
Amertiptyline is one of the worst drugs that cause death