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Patient has been feeling down lately. History of depression. Current Effexor use.
There is a terminal R wave in AVR. This can be seen in sodium channel blockade e.g. TCA (tricyclic antidepressants ) toxicity.
Possible Effexor OD or had some old TCA and downed the bottle.
Concern for ventricular arrhythmia from sodium channel blockade toxicity.
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