TMSS Medical College Journal

Background: Organophosphate compound (OPC) poisoning represents a major health problem in developing countries like Bangladesh. Like other systems, cardiac manifestations also often accompany them which is manifested by ECG changes. Objeetive: This study aimed to determine the ECG changes in patients with OP poisoning with their association with severity and prognosis. Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh from September 2017 to November 2019. A total of 101 OPC poisoning patients were included. After receiving informed written consent relevant information was gathered by taking history, clinical examination, and ECG was done during admission. The severity of OPC poisoning was determined by the Peradeniya organophosphorus poisoning (POP) scale. Collected data were analyzed by statistical software SPSS 22. Results: In this study, the mean age of the study subjects was 30.97+9.88 (SD) with males (58.40%) predominant. Most of the poisoning cases (73.30%) showed electrocardiographic changes which include sinus tachycardia 40.60%, prolonged QTc 25.70%, sinus bradycardia 23.80%, ST depression 11.90%, T inversion 5.90%, ST-segment elevation 3.96%, PR prolongation 1.98%, Atrial fibrillation 1.98% and extra systole 0.99%. Both outcome and severity of the patients were significantly associated with Sinus Bradycardia, Atrial fibrillation and QTc prolongation (p<.05). Logistic regression analysis revealed Sinus bradycardia and Prolongation of QT as an independent predictor of mortality of OPC poisoning. Conclusion: Early detection of ECG abnormalities can be an important issue regarding the effective management of OPC poisoning patients as it is significantly related to severity and prognosis.

The World Health Organization (WHO) has identified pesticide poisoning as a leading cause of public health problems. Globally, death from deliberate ingestion of pesticides claimed more than 168000 lives every year, which accounts for 20% of all suicides.’ The majority of these incidents were reported from developing countries (Kamaruzaman et al. 2020).** Among these pesticides most commonly used is the organophosphorus compounds (OPC). Due to their easy availability, it is widely used for deliberate and accidental poisoning. In Bangladesh, an estimated caseload of OPC poisoning in hospitals is 7.1% of total admissions.® OPC insecticides cause inhibition of cholinesterase activity resulting in accumulation of acetylcholine at synapses, causing overstimulation and disruption of neurotransmission in both central and peripheral nervous systems.*’Additionally, cardiac manifestations of OPC poisoning occur in a majority of the affected patients. It can be assessed by simple electrocardiographic changes’ In most patients, ECG may show simple effects to lethal changes due to the poisoning. These include sinus tachycardia, repolarization abnormalities including ST segment deviation and T wave abnormalities, extra systole, Q-T prolongation, and A-V blocks. These changes also predict the severity and outcome of the poisoning. A significant association has been linked between ST segment alterations in ECG with poisoning outcomes.” QTc prolongation has shown significant on the severity of