A 39-year-old man was transferred to the emergency department by ambulance due to loss of consciousness and hypotension (70/40 mmHg). The patient had a medical history of depression, for which he was taking nortriptyline [tricyclic antidepressant (TCA)]. The electrocardiogram (Panel A) showed several features consistent with TCA intoxication, i.e. tachycardia, QRS prolongation, a pronounced terminal R wave in lead aVR, and rightward shift of the terminal QRS vector. This shift typically occurs because of an intraventricular and interventricular conduction delay resulting in delayed right ventricular activation. Transthoracic echocardiography (Supplementary material onlineSupplementary material online, Videos SA and SB) revealed a severe contraction dyssynchrony, caused by extreme conduction delay. The interventricular septum contracted in a ‘stadium wave-like pattern’ (Panels B–D). Toxicological analysis confirmed the diagnosis of severe TCA intoxication.

中文翻译：

---

三环类抗抑郁药中毒时，由于极度的传导延迟，导致“ Stadium波状”心室收缩。

一名39岁的男子因失去知觉和低血压（70/40 mmHg）被救护车送往急诊室。该患者有抑郁症的病史，正在服用去甲替林[三环抗抑郁药（TCA）]。心电图（图A）显示出与TCA中毒相一致的几个特征，如心动过速，QRS延长，aVR导联中明显的终末R波以及终末QRS向量向右移位。这种移位通常是由于心室内和心室之间的传导延迟而导致右心室激活延迟而发生的。经胸超声心动图（在线补充材料，视频SA和SB）显示由于严重的传导延迟导致严重的收缩不同步。室间隔呈“体育场波状”收缩（图B–D）。毒理学分析证实了严重TCA中毒的诊断。