Coma with ECG abnormalities: consider tricyclic antidepressant intoxication.

Two comatose patients with a psychiatric history were admitted to our hospital. On admission both presented with major cardiovascular instability and needed urgent intensive care treatment. Although initially not suspected, the coma was caused by tricyclic antidepressant intoxication (TCA). Serious neurological, anticholinergic and cardiovascular effects may occur in TCA intoxication. In any comatose patient with ECG changes and a psychiatric history, TCA intoxication should be strongly suspected.