Spectrum of Electrocardiographic Changes in Patients Presenting with Acute Organophosphate Compounds Poisoning

Abstract

BACKGROUND Organophosphate compounds (OPC) are important cause of poisoning in developing countries. They are irreversible cholinesterase inhibitors and produce signs and symptoms pertaining to various organ systems via their muscarinic and nicotinic effects. The cardiac manifestations include hemodynamic instability and various arrhythmias. Here, in this study, we described various electrocardiographic (ECG) changes in patients of OPC poisoning in our population. METHODS This is a descriptive, cross-sectional study conducted at tertiary academic centre. All patients (>14 years and < 75 years) with history of OPC poisoning were included. Diagnosis was made on the basis of history and clinical features. ECG analysis of each patient was done for rate, rhythm, ST segment and T wave changes, PR and QTc interval, conduction defects and atrial and ventricular premature complexes before and after administration of atropine. RESULTS A total of 54 patients with OPC poisoning were included. The mean age was 28 ± 14.5 years. The predominant age group was < 30 years. There was female predominance with male : female ratio of 1 : 1.45. The most common ECG finding was sinus arrhythmia (tachycardia 25.9 % and bradycardia 20.4 %), followed by prolonged QTc (14.8 %), ST - T changes (11.1 %), premature ventricular complexes (PVCs) (7.4 %), prolonged PR interval (3.7 %) and atrial fibrillation (1.9 %). There was no mortality. The mean ICU and Hospital stay was three and six days respectively. CONCLUSIONS Sinus arrhythmia was the most common ECG changes followed by prolonged QTc, ST - T segment changes and PVCs in our setup. Careful observation of these ECG changes and timely intervention can prevent from sudden cardiac death in these patients. KEY WORDS Cardiac, Complications, Electrocardiogram, Organophosphates, Poisoning