Acquired QT Prolongation Associated with Esophagitis and Acute Weight Loss:How to Evaluate a Prolonged QT Interval

Recent reports have suggested an increased risk of QT prolongation and subsequent life-threatening ventricular arrhythmias, particularly torsade de pointes, in patients with coronavirus disease-2019 (COVID-19) treated with hydroxychloroquine and azithromycin. In this article, we report the case of a 75-year-old female with a baseline prolonged QT interval in whom the COVID-19 illness resulted in further remarkable QT prolongation (>700 ms), precipitating recurrent self-terminating episodes of torsade de pointes that necessitated temporary cardiac pacing. Despite the correction of hypoxemia and the absence of reversible factors, such as adverse medication effects, electrolyte derangements, and usage of hydroxychloroquine/azithromycin, the QT interval remained persistently prolonged compared with the baseline with subsequent degeneration into ventricular tachycardia and death. Thus, we highlight that COVID-19 illness itself can potentially lead to further prolongation of QT interval and unmask fatal ventricular arrhythmias in patients who have a prolonged QT and low repolarization reserve at baseline.

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Wide Complex Tachycardia

10.2310/em.4703 ◽

2016 ◽

Author(s):

Gary Green ◽

Sally Graglia

Keyword(s):

Ventricular Tachycardia ◽

Qt Interval ◽

Systolic Heart Failure ◽

Left Ventricular ◽

Qt Prolongation ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Wpw Syndrome ◽

Prolonged Qt Interval ◽

Prolonged Qt

Wide-complex tachycardias (WCTs) should always alert the emergency physician to a potentially immediate or rapidly developing, life-threatening scenario. The approach to these patients should follow general emergency medicine principles. The review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of WCT. Figures show a basic electrocardiogram (ECG) tracing, an ambulatory monitoring strip of a patient with recurrent presyncope showing repetitive monomorphic ventricular tachycardia, a 12-lead ECG of a rapid wide QRS tachycardia due to an antidromic atrioventricular reciprocating tachycardia in a patient with Wolff-Parkinson-White (WPW) syndrome, an example of pacemaker-mediated tachycardia, ventricular tachycardia occurring in the context of QT prolongation consistent with torsades de pointes, a 12-lead ECG in a patient with WPW syndrome showing a rapid, irregular ventricular rate and wide QRS complexes of atrial fibrillation with a short refractory period, an ECG representative of tricyclic antidepressant overdose, and an algorithm for identifying patients with systolic heart failure and left ventricular ejection fraction less than or equal to 35% who are candidates for an implantable cardioverter-defibrillator. Tables list causes of regular WCT, causes of prolonged QT interval, common medications with potential QT prolongation activity, pharmacologic treatment options for stable patients with WCT, Kindwall and colleagues’ criteria for ventricular tachycardia, Brugada and colleagues’ criteria for ventricular tachycardia, Vereckei and colleagues’ aVr algorithm for the diagnosis of ventricular tachycardia, and a comparison of self-reported sensitivities, specificities, and test accuracies of the algorithms presented by Kindwall, Brugada, and Vereckei and their colleagues. Key words: prolonged QT interval, supraventricular tachycardia, ventricular tachycardia, wide-complex tachycardias This review contains 8 highly rendered figures, 8 tables, and 59 references.

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A review of ECG and QT interval measurement use in a public psychiatric inpatient setting

Australasian Psychiatry ◽

10.1177/1039856217726212 ◽

2017 ◽

Vol 26 (1) ◽

pp. 50-55 ◽

Cited By ~ 6

Author(s):

Ingrid Berling ◽

Rahul Gupta ◽

Cecilia Bjorksten ◽

Felicity Prior ◽

Ian M Whyte ◽

...

Keyword(s):

Mental Health ◽

Qt Interval ◽

Psychiatric Inpatient ◽

Torsades De Pointes ◽

Qt Prolongation ◽

Inpatient Unit ◽

Inpatient Setting ◽

Prolonged Qt Interval ◽

Prolonged Qt ◽

Clinically Significant

Objectives: There is an increased rate of sudden cardiac death (SCD) in mental health patients. Some antipsychotic medications are known to prolong the QT interval, thus increasing a patient’s risk of SCD via the arrhythmia, torsades de pointes (TdP). Our aim was to evaluate assessment for QT prolongation within a public inpatient mental health facility by auditing electrocardiograph (ECG) use. Methods: We reviewed records of all mental health inpatient admissions to a public emergency mental health inpatient unit between 1 January 2016 and 11 February 2016. ECG availability was noted and QT interval was manually measured and assessed for risk of TdP using the QT nomogram when present. Demographic information and medication use was collected. Results: Of 263 mental health inpatient admissions, 50 (19%) presentations had an ECG. A total of four (8%) had a prolonged QT interval. Of the 50 patients with an ECG, 12 (24%) were taking medication known to prolong the QT interval. Conclusions: There was very limited risk assessment for QT prolongation in a public hospital psychiatric inpatient unit, with less than 20% of patients having an ECG performed. Our study supports an association between QT-prolonging drugs and a clinically significant prolonged QT interval; however, a larger study with routine ECG screening is required.

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Drug-Induced QT Prolongation as a Result of an Escitalopram Overdose in a Patient with Previously Undiagnosed Congenital Long QT Syndrome

Case Reports in Medicine ◽

10.1155/2014/917846 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Paul Singh ◽

J. Martin Maldonado-Duran

Keyword(s):

Qt Interval ◽

Torsades De Pointes ◽

Qt Prolongation ◽

Long Qt ◽

Drug Induced ◽

Prolonged Qt Interval ◽

Prolonged Qt ◽

Qt Syndrome ◽

Congenital Lqts ◽

Congenital Long Qt Syndrome

We present a case of drug-induced QT prolongation caused by an escitalopram overdose in a patient with previously undiagnosed congenital LQTS. A 15-year-old Caucasian female presented following a suicide attempt via an escitalopram overdose. The patient was found to have a prolonged QT interval with episodes of torsades de pointes. The patient was admitted to the telemetry unit and treated. Despite the resolution of the torsades de pointes, she continued to demonstrate a persistently prolonged QT interval. She was seen by the cardiology service and diagnosed with congenital long QT syndrome. This case illustrates the potential for an escitalopram overdose to cause an acute QT prolongation in a patient with congenital LQTS and suggests the importance of a screening electrocardiogram prior to the initiation of SSRIs, especially in patients at high risk for QT prolongation.

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Acquired QT Prolongation Associated With Esophagitis and Acute Weight Loss: How to Evaluate a Prolonged QT Interval

Yearbook of Pediatrics ◽

10.1016/s0084-3954(08)70114-3 ◽

2007 ◽

Vol 2007 ◽

pp. 206-207

Author(s):

J.A. Stockman

Keyword(s):

Weight Loss ◽

Qt Interval ◽

Qt Prolongation ◽

Prolonged Qt Interval ◽

Prolonged Qt

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Abstract 308: Aortic Valve Stenosis Causes Both Delayed Ventricular Depolarization and Repolarization

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.36.suppl_1.308 ◽

2016 ◽

Vol 36 (suppl_1) ◽

Author(s):

Zakir Shaik ◽

Amanulla Khaji ◽

Scott Goldman ◽

Roberto Rodriguez ◽

Francis P Sutter ◽

...

Keyword(s):

Aortic Valve ◽

Sinus Rhythm ◽

Aortic Valve Stenosis ◽

Qt Interval ◽

Qt Prolongation ◽

Valve Repair ◽

Qrs Duration ◽

Prolonged Qt Interval ◽

Prolonged Qt ◽

Ventricular Depolarization

Background: Increased QRS duration (QRSD), a common ECG finding in patients (pts) with aortic valve stenosis (AVS), can result in false QT prolongation. This study aimed to test a hypothesis that in AVS delayed ventricular repolarization is independent from the delayed depolarization. Methods: In a retrospective AVS study, ECGs prior to valve repair/replacements were evaluated. QRSD and QTc (Bazett's) were compared between pts with severe and non severe AVS. ECGs showing QRSD > 120 ms or non-sinus rhythm were excluded for analysis. In pts with both wider QRS and longer QT interval (QTc > 440 ms), JT (QT-QRSD) was used to determine the repolarization time. Results: Pts with severe AVS (n=219) had longer QRSD [100 (16) ms vs. 88 (12) ms, p<0.001], with QTc ≥ 450 ms seen in 53%. JT is much longer in the ALQTS group (Table 1). More pts had QTc ≥ 470 ms (33% vs 23%, p<0.05) in the severe AVS than the non-severe AVS. Conclusion: A wider QRS and higher prevalence of moderate to markedly prolonged QT interval in pts with severe AVS indicates AVS itself can result in a delay of both ventricular depolarization and repolarization.

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The effect of sex and underlying disease on the genetic association of QT interval and sudden cardiac death

10.1101/664300 ◽

2019 ◽

Author(s):

Rebecca N. Mitchell ◽

Foram N. Ashar ◽

Marjo-Riitta Jarvelin ◽

Philippe Froguel ◽

Nona Sotoodehnia ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Genetic Association ◽

Qt Interval ◽

Cardiac Death ◽

Mendelian Randomization ◽

Underlying Disease ◽

Qt Prolongation ◽

Causal Association ◽

Prolonged Qt Interval ◽

Prolonged Qt

ABSTRACTBackgroundSudden cardiac death (SCD) accounts for ~300,000 deaths annually in the US. Men have a higher risk of SCD and are more likely to have underlying coronary artery disease (CAD) than women. In contrast, women are more likely to have arrhythmic events in the setting of inherited or acquired QT prolongation. Moreover, there is evidence of sex differences in the underlying genetics of QT interval duration. Using sex- and CAD-stratified analyses, we assess differences in genetic association between prolonged QT interval and SCD risk.MethodsWe examined 2,282 SCD subjects with autopsy-confirmed underlying disease from the Fingesture cohort and 3,561 Finnish controls. The SCD subjects were stratified by underlying disease (ischemic vs. non-ischemic) and by sex. We used logistic regression to test for association between the top QT interval associated SNP, rs12143842 (in the NOS1AP locus), and SCD risk. We also performed Mendelian randomization to test for causal association of QT interval in the various subgroups.ResultsFemale SCD victims with underlying non-ischemic disease had the strongest association between rs12143842 and SCD risk (OR=1.37; 95% CI, 1.07-1.75) and the strongest causal association, established using Mendelian randomization, between prolonged QT interval and SCD (OR in SCD risk per SD increase in QT, 3.60; 95% CI, 1.22-10.49). Ischemic SCD victims, irrespective of sex, did not show an association between rs12143842 and SCD risk or a causal association for QT interval.ConclusionsThis study provides evidence that the causal effect of QT prolongation on SCD risk differs by sex and underlying disease.

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