Ventricular arrhythmias complicating weight reduction therapy in a patient with 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.

Download Full-text

Fluctuating QTc interval in an asymptomatic patient treated with methadone for chronic pain

Journal of Opioid Management ◽

10.5055/jom.2005.0019 ◽

2005 ◽

Vol 1 (2) ◽

pp. 73 ◽

Cited By ~ 9

Author(s):

Katherine Ower, MD, FRCPC ◽

Patricia Morley-Forster, MD, FRCPC ◽

Dwight Moulin, MD, FRCPC

Keyword(s):

Chronic Pain ◽

Qt Interval ◽

Ventricular Arrhythmias ◽

Pain Syndrome ◽

Qtc Interval ◽

Electrolyte Disturbances ◽

Prolonged Qt Interval ◽

Prolonged Qt ◽

Prolonged Qt Syndrome ◽

Not At Risk

Prolongation of the QT interval associated with ventricular arrhythmias has been the most common cause of the restriction or withdrawal of drugs from the market in the past 10 years. Methadone, a synthetic opioid that is increasingly used for the management of chronic pain, has recently been implicated in the development of the prolonged QT syndrome. We present a case report of a patient who developed a prolonged QT while being treated with oral methadone for a chronic pain syndrome. Of particular interest in this patient is the fluctuation of the QT interval at a stable dose of methadone, suggesting that a single normal electrocardiogram (ECG) does not guarantee that the patient is not at risk of ventricular arrhythmias. After reviewing the current literature, we suggest that there is no dose of methadone that may be considered to be completely safe. Other risk factors for prolonged QT interval such as underlying cardiac abnormalities, electrolyte disturbances, and concurrent medications should be sought, and all patients should be monitored with serial ECGs even when methadone doses remain stable.

Download Full-text

Drug-induced ventricular arrhythmias: Prolonged QT interval

Annals of Emergency Medicine ◽

10.1016/s0196-0644(82)80453-8 ◽

1982 ◽

Vol 11 (10) ◽

pp. 597-598

Author(s):

David Bar-Or

Keyword(s):

Qt Interval ◽

Ventricular Arrhythmias ◽

Drug Induced ◽

Prolonged Qt Interval ◽

Prolonged Qt

Download Full-text

Prolonged QT interval during diabetic ketoacidosis: A case series

Endocrine Abstracts ◽

10.1530/endoabs.70.aep408 ◽

2020 ◽

Author(s):

Ghariani Rania ◽

Chrif Yosra ◽

Samar Derbal ◽

Rihab Laamouri ◽

Fatma Ben Dahmene ◽

...

Keyword(s):

Diabetic Ketoacidosis ◽

Qt Interval ◽

Case Series ◽

Prolonged Qt Interval ◽

Prolonged Qt

Download Full-text

Assessing risk of a prolonged QT interval–a survey of emergency physicians

International Journal of Emergency Medicine ◽

10.1007/s12245-008-0014-6 ◽

2008 ◽

Vol 1 (1) ◽

pp. 35-41 ◽

Cited By ~ 3

Author(s):

Amanda S. Y. Chan ◽

Geoffrey K. Isbister ◽

Carl M. J. Kirkpatrick ◽

Stephen B. Duffull

Keyword(s):

Qt Interval ◽

Emergency Physicians ◽

Prolonged Qt Interval ◽

Prolonged Qt

Download Full-text

Electrocardiogram with prolonged QT interval in Gitelman disease

Kidney International ◽

10.1046/j.1523-1755.2002.00467.x ◽

2002 ◽

Vol 62 (2) ◽

pp. 580-584 ◽

Cited By ~ 52

Author(s):

Alberto Bettinelli ◽

Camillo Tosetto ◽

Giacomo Colussi ◽

Ginaluca Tommasini ◽

Alberto Edefonti ◽

...

Keyword(s):

Qt Interval ◽

Prolonged Qt Interval ◽

Prolonged Qt

Download Full-text

Prolonged QT interval and cocaine use

Journal of Electrocardiology ◽

10.1016/s0022-0736(97)80047-7 ◽

1997 ◽

Vol 30 (4) ◽

pp. 337-339 ◽

Cited By ~ 36

Author(s):

Rohan Perera ◽

Andreas Kraebber ◽

Miles J. Schwartz

Keyword(s):

Qt Interval ◽

Cocaine Use ◽

Prolonged Qt Interval ◽

Prolonged Qt

Download Full-text

Prolonged QTc: "Mind the Gap"

Bangladesh Critical Care Journal ◽

10.3329/bccj.v2i1.19970 ◽

2014 ◽

Vol 2 (1) ◽

pp. 44-45

Author(s):

Ahmad Mursel Anam ◽

Raihan Rabbani ◽

Farzana Shumy ◽

M Mufizul Islam Polash ◽

M Motiul Islam ◽

...

Keyword(s):

Cardiac Arrest ◽

Long Qt Syndrome ◽

Qt Interval ◽

Torsades De Pointes ◽

Junior Doctors ◽

Long Qt ◽

Acquired Long Qt Syndrome ◽

Prolonged Qt Interval ◽

Prolonged Qt ◽

Qt Syndrome

We report a case of drug induced torsades de pointes, following acquired long QT syndrome. The patient got admitted for shock with acute abdomen. The initial prolonged QT-interval was missed, and a torsadogenic drug was introduced post-operatively. Patient developed torsades de pointes followed by cardiac arrest. She was managed well and discharged without complications. The clinical manifestations of long QT syndromes, syncope or cardiac arrest, result from torsades de pointes. As syncope or cardiac arrest have more common differential diagnoses, even the symptomatic long QT syndrome are commonly missed or misdiagnosed. In acquired long QT syndrome with no prior suggestive feature, it is not impossible to miss the prolonged QT-interval on the ECG tracing. We share our experience so that the clinicians, especially the junior doctors, will be more alert on checking the QT-interval even in asymptomatic patients. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19970 Bangladesh Crit Care J March 2014; 2 (1): 44-45

Download Full-text

Chloroquine-induced Prolonged QT Interval in COVID-19 Patients in Indonesia: Case Series

Biomedical & Pharmacology Journal ◽

10.13005/bpj/2094 ◽

2021 ◽

Vol 14 (1) ◽

pp. 01-05

Author(s):

Putu Dyah Widyaningsih ◽

Putu Gita Pranata Putra ◽

DG Wedha Asmara ◽

Erna Bagiari ◽

Agus Santosa ◽

...

Keyword(s):

Qt Interval ◽

Virus Disease ◽

Case Series ◽

Corona Virus ◽

Prolonged Qt Interval ◽

Prolonged Qt ◽

Anti Inflammation

The treatment of corona virus disease 2019 (COVID-19)remains in debate, and the use of chloroquine has not been validated by accurate clinical trials.The aim of this study was to provide the possible cardiotoxicity effect of chloroquine in patients with COVID-19. This study was a case-series of prolonged QT interval of COVID-19 patients treated with chloroquine in a hospital in Bali, Indonesia. There were two cases of COVID-19 with exhibited a prolonged QT interval after being administrated of chloroquine. The prolonged QT interval returned to normal after chloroquine was stopped.These cases alert us the cardiotoxicity effect of chloroquine and the need for serial electro-cardiography monitoring before and during therapy. In conclusion, although antiviral and anti-inflammation properties of chloroquine on COVID-19 are promising, its cardiotoxicity effects should be monitored closely for less harm to the patients.

Download Full-text

Lack of efficacy of hydroxychloroquine and azithromycin in patients hospitalized for COVID-19 pneumonia: A retrospective study

PLoS ONE ◽

10.1371/journal.pone.0252388 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252388

Author(s):

Anis Saib ◽

Walid Amara ◽

Pascal Wang ◽

Simon Cattan ◽

Azeddine Dellal ◽

...

Keyword(s):

Mechanical Ventilation ◽

Retrospective Study ◽

Propensity Score ◽

Propensity Score Matching ◽

Qt Interval ◽

Treatment Cessation ◽

Composite Outcome ◽

Prolonged Qt Interval ◽

Prolonged Qt

Background Hydroxychloroquine combined with azithromycin (HCQ/AZI) has initially been used against coronavirus disease-2019 (COVID-19). In this retrospective study, we assessed the clinical effects of HCQ/AZI, with a 28-days follow-up. Methods In a registry-study which included patients hospitalized for COVID-19 between March 15 and April 2, 2020, we compared patients who received HCQ/AZI to those who did not, regarding a composite outcome of mortality and mechanical ventilation with a 28-days follow-up. QT was monitored for patients treated with HCQ/AZI. Were excluded patients in intensive care units, palliative care and ventilated within 24 hours of admission. Three analyses were performed to adjust for selection bias: propensity score matching, multivariable survival, and inverse probability score weighting (IPSW) analyses. Results Overall, 203 patients were included: 60 patients treated by HCQ/AZI and 143 control patients. During the 28-days follow-up, 32 (16.3%) patients presented the primary outcome and 23 (12.3%) patients died. Propensity-score matching identified 52 unique pairs of patients with similar characteristics. In the matched cohort (n = 104), HCQ/AZI was not associated with the primary composite outcome (log-rank p-value = 0.16). In the overall cohort (n = 203), survival and IPSW analyses also found no benefit from HCQ/AZI. In the HCQ/AZI group, 11 (18.3%) patients prolonged QT interval duration, requiring treatment cessation. Conclusions HCQ/AZI combination therapy was not associated with lower in-hospital mortality and mechanical ventilation rate, with a 28-days follow-up. In the HCQ/AZI group, 18.3% of patients presented a prolonged QT interval requiring treatment cessation, however, control group was not monitored for this adverse event, making comparison impossible.

Download Full-text