Prolonged QT period in diabetic autonomic neuropathy: A possible role in sudden cardiac death?

BACKGROUND: Prolonged cardiac repolarization is associated with ventricular tachycardia and sudden cardiac death. Repolarization, represented by the QT interval, is usually measured on a 12-lead ECG recording. Measurements of the interval on bedside monitor ECG recordings have not been compared quantitatively with measurements on 12-lead ECG recordings. OBJECTIVE: To determine if QT intervals and QTc values obtained by using monitor recordings are as accurate as those obtained by using 12-lead ECG recordings. METHODS: For each of 50 subjects, 2 ECG recordings were obtained, 1 with a 12-lead ECG and 1 with the bedside monitor, and QT intervals were measured manually. The QT intervals on each type of recording were compared on a lead-by-lead basis, the maximum QT interval and the QTc maximum determined with each method were compared, and the "best single leads" for determining the QTc were ascertained for each method. RESULTS: QT intervals, on a lead-by-lead basis; maximum QT intervals; and QTc maximum values measured on the monitor recordings were consistently longer than those measured on the 12-lead ECG recordings. When the monitor ECG leads I or II and the 12-lead ECG QTc maximum were examined for simple agreement by using 460 milliseconds as a cutoff, agreement was found in 82% to 84% of the sample, and false negatives were 12% and 8%, respectively. CONCLUSION: Recordings from leads I or II on the bedside ECG monitor should be used to measure the QT interval. Once prolonged QT values are detected, recordings obtained with a 12-lead ECG can be used to confirm the analysis.

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Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis

PLoS ONE ◽

10.1371/journal.pone.0127213 ◽

2015 ◽

Vol 10 (6) ◽

pp. e0127213 ◽

Cited By ~ 10

Author(s):

Antoine Poncet ◽

Baris Gencer ◽

Marc Blondon ◽

Marianne Gex-Fabry ◽

Christophe Combescure ◽

...

Keyword(s):

Cost Effectiveness ◽

Sudden Cardiac Death ◽

Qt Interval ◽

Cardiac Death ◽

Psychiatric Patients ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis ◽

Prolonged Qt Interval ◽

Prolonged Qt

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Impaired Hypoxic Ventilatory Drive Induced by Diabetic Autonomic Neuropathy, A Cause of Misdiagnosed Severe Cardiac Events. Brief Report of Two Cases.

10.21203/rs.3.rs-115411/v1 ◽

2020 ◽

Author(s):

Louis Schubert ◽

Suzanne Laroche ◽

Agnès Hartemann ◽

Olivier Bourron ◽

Franck Phan

Keyword(s):

Respiratory Failure ◽

Sudden Cardiac Death ◽

Autonomic Neuropathy ◽

Cardiac Death ◽

Clinical Signs ◽

Cardiac Autonomic Neuropathy ◽

Diabetic Patients ◽

Cardiac Events ◽

Cardiorespiratory Arrest ◽

Ventilatory Drive

Abstract Background: Sudden cardiac death are twice more frequent in diabetic patients with cardiac autonomic neuropathy. Sudden cardiac death etiologies remain unclear and no recommendation are made to identify factor associated with cardiorespiratory arrest in diabetic patients. We hypothesized, from two clinical cases, that impaired hypoxic ventilatory drive, induced by diabetic autonomic neuropathy, is a cause of misdiagnosed severe cardiac events.Case presentation: We describe the cases of two patients with isolated low blood saturation on pulse oximeter during the systematic nurse check-up (77% and 85% respectively) contrasting with the absence of any complaint as well as any dyspnea, polypnea or other respiratory insufficiency signs observed during the clinical examination. Arterial blood gas measurements subsequently confirmed that blood saturation was low and that both patients were indeed hypoxemic. Patient 1 suffered of vascular overload complicated by cardiac arrest caused by hypoxemia in light of the quick recovery observed after ventilation. Pulmonary edema was diagnosed in patient 2. The common denominator of these 2 cases described in this brief report is the absence of respiratory failure clinical signs contrasting with the presence of confirmed hypoxemia. Also, in both cases, such absence of precursory signs seems to be induced by an impaired ventilatory drive to hypoxemia. This appears to be related to the autonomic diabetic neuropathy encountered in those 2 patients.Conclusions: Therefore, we describe, in this brief report, cardiac autonomic neuropathy as a cause of impaired hypoxic ventilatory drive involved in severe acute cardiorespiratory events in two type 1 diabetic patients. We assume that altered response to hypoxemia due to cardiac autonomic neuropathy and non-functional central neurological breathing command could play a key role in sudden deaths among diabetic patients. A point to emphasize is that hypoxemia can be easily missed since no clinical signs of respiratory failure are reported in these two clinical cases. Systematic screening of cardiac autonomic neuropathy in diabetic patients and proactive detection of impaired hypoxic ventilatory drive for early management (e.g. treatment of hypoxemia) should be systematically undertaken in diabetic patients to prevent its dramatic consequences such as cardiorespiratory arrest and death.

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