scholarly journals Idiopathic Intractable Diarrhoea Leading to Torsade de Pointes

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Kyriacos Mouyis ◽  
Darlington Okonko ◽  
Constantinos G. Missouris
Keyword(s):  
Torsade De Pointes ◽  
Polymorphic Ventricular Tachycardia ◽  
Chronic Diarrhoea ◽  
Qtc Interval ◽  
Low Potassium ◽  
Life Threatening ◽  
History Of ◽  
Artery Disease ◽  
Electrocardiogram Ecg ◽  
Multiple Episodes

An 81-year-old lady was admitted to our hospital with a 3-year history of noninfective diarrhoea and recurrent syncopal events over the last 3 months. Her initial electrocardiogram (ECG) revealed trigeminy and prolonged QTc interval. She had a structurally normal heart with no coronary artery disease. Investigations revealed low potassium at 3.0 mmol/L. Sigmoidoscopy and colonoscopy suggested a possible diagnosis of diverticulitis. Soon after admission she had an unresponsive episode with spontaneous recovery. Telemetry and Holter analysis confirmed multiple episodes of polymorphic ventricular tachycardia (Torsade de Pointes). Following electrolyte supplementation the episodes of polymorphic VT improved. Due to the protracted nature of the diarrhoea, the recurrent syncopal events, and recurrent hypokalaemia documented over recent years, an Implantable Cardioverter Defibrillator (ICD) was sanctioned by the multidisciplinary team (MDT). In summary, chronic diarrhoea may result in life threatening polymorphic VT due to hypokalaemia and QTc prolongation. In these patients an ICD may be considered.

scholarly journals Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 205
Author(s):  
Nicola Tarantino ◽  
Domenico G. Della Rocca ◽  
Nicole S. De Leon De La Cruz ◽  
Eric D. Manheimer ◽  
Michele Magnocavallo ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Individual Factors ◽  
Substantial Part ◽  
Arrhythmogenic Substrate ◽  
Life Threatening ◽  
History Of ◽  
Anatomic Distribution ◽  
Artery Disease ◽  
Surveillance Analysis

A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.

Possible GoLytely-Associated Cardiac Arrest: A Case Report and Literature Review

2019 ◽  
Vol 33 (3) ◽  
pp. 364-367 ◽  
Author(s):  
Yoonsun Mo ◽  
Shiv Gandhi ◽  
Jose Orsini
Keyword(s):  
Cardiac Arrest ◽  
Abdominal Pain ◽  
Sudden Cardiac Arrest ◽  
Lower Abdominal Pain ◽  
The Past ◽  
Life Threatening ◽  
History Of ◽  
Artery Disease ◽  
Possible Cause

Purpose: To report a case of sudden cardiac arrest possibly associated with the administration of GoLytely® (polyethylene glycol 3350 and electrolytes). Summary: A 60-year-old male with a history of hypertension, hyperlipidemia, type 2 diabetes, and coronary artery disease presented to the emergency department with complaints of constipation and lower abdominal pain over the past week, and the inability to urinate over the past day. The patient had received GoLytely as treatment to alleviate symptoms of constipation and abdominal pain. However, several hours after administration of the bowel prep solution, the patient suffered an episode of cardiac arrest. After ruling out other possible etiologies, GoLytely was suspected as a possible cause of cardiac arrest. The patient had suffered an anoxic brain injury and remained intubated and unconscious until he eventually expired, 20 days after the event. Conclusion: Although GoLytely appears to be a safe agent with fewer side effects, clinicians need to be mindful of potential life-threatening adverse events following GoLytely administration and monitor patients closely during and after administration.

scholarly journals The effects of thioridazine on the QTc interval - cardiovascular safety in a South African setting

2005 ◽  
Vol 11 (2) ◽  
pp. 5
Author(s):  
Cathlene Seller ◽  
Piet Oosthuizen
Keyword(s):  
South African ◽  
Torsade De Pointes ◽  
Qtc Interval ◽  
Line Treatment ◽  
Interval Prolongation ◽  
First Line ◽  
Qt Interval Prolongation ◽  
Baseline Values ◽  
Electrocardiogram Ecg ◽  
African Setting

Background. Thioridazine has long been used as a first-line antipsychotic in South Africa without any apparent problems. Recently the American Food and Drug Administration (FDA) and Novartis have warned of potentially lethal arrhythmias that may result from the use of thioridazine. Abnormal QT-interval prolongation on the electrocardiogram (ECG) seems to be the most reliable indicator of risk of arrhythmias, such as torsade de pointes and ventricular fibrillation.Objective. The purpose of this study was to determine whether these warnings are of clinical relevance in a setting where there are already a limited number of antipsychotics available.Method. Thirty hospitalised subjects who required switching from a high-potency to a low-potency antipsychotic were included. All subjects were commenced on thioridazine 300 mg per day and had an ECG 1 week after initiation and 48 hours after each dose adjustment. QTc was determined using Bazett’s formula.Results. Thioridazine induced a significant increase (p = 0.0001) in QTc interval from baseline values of 400.6 (± 27.3) milliseconds to 429.1 (± 44.2) milliseconds. The QTc interval increased to above 450 milliseconds in 7 subjects (23%) and thioridazine was discontinued in 2 subjects because of a QTc interval greater or equal to 500 milliseconds.Conclusion. Thioridazine caused a significant, although asymptomatic, increase in QTc interval in almost one-quarter of subjects who received the medication as second-line treatment. Thioridazine should no longer be used as a first-line treatment and if used it should be accompanied by regular ECG monitoring.

scholarly journals Drugs and life-threatening ventricular arrhythmia risk: results from the DARE study cohort

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016627 ◽  
Author(s):  
Abigail L Coughtrie ◽  
Elijah R Behr ◽  
Deborah Layton ◽  
Vanessa Marshall ◽  
A John Camm ◽  
...  
Keyword(s):  
Family History ◽  
Sudden Death ◽  
Polymorphic Ventricular Tachycardia ◽  
Study Cohort ◽  
Qtc Interval ◽  
Acute Ischaemia ◽  
Cardiovascular Comorbidity ◽  
Patient Reported ◽  
History Of ◽  
Multiple Drugs

ObjectivesTo establish a unique sample of proarrhythmia cases, determine the characteristics of cases and estimate the contribution of individual drugs to the incidence of proarrhythmia within these cases.SettingSuspected proarrhythmia cases were referred by cardiologists across England between 2003 and 2011. Information on demography, symptoms, prior medical and drug histories and data from hospital notes were collected.ParticipantsTwo expert cardiologists reviewed data for 293 referred cases: 130 were included. Inclusion criteria were new onset or exacerbation of pre-existing ventricular arrhythmias, QTc >500 ms, QTc >450 ms (men) or >470 ms (women) with cardiac syncope, all secondary to drug administration. Exclusion criteria were acute ischaemia and ischaemic polymorphic ventricular tachycardia at presentation, structural heart disease, consent withdrawn or deceased prior to study. Descriptive analysis of Caucasian cases (95% of included cases, n=124) and culpable drug exposures was performed.ResultsOf the 124 Caucasian cases, 95 (77%) were QTc interval prolongation-related; mean age was 62 years (SD 15), and 63% were female. Cardiovascular comorbidities included hypertension (53%) and patient-reported ‘heart rhythm problems’ (73%). Family history of sudden death (36%) and hypokalaemia at presentation (27%) were common. 165 culpable drug exposures were reported, including antiarrhythmics (42%), of which amiodarone and flecainide were the most common. Sotalol, a beta-blocking agent with antiarrhythmic activity, was also common (15%). 26% reported multiple drugs, of which 84% reported at least one cytochrome (CYP) P450 inhibitor. Potential pharmacodynamics interactions identified were mainly QT prolongation (59%).ConclusionsAntiarrhythmics, non-cardiac drugs and drug combinations were found to be culpable in a large cohort of 124 clinically validated proarrhythmia cases. Potential clinical factors that may warn the prescriber of potential proarrhythmia include older women, underlying cardiovascular comorbidity, family history of sudden death and hypokalaemia.

scholarly journals The QT long syndrome: clinical and diagnostic aspect

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Constantin Martiniuc ◽  
◽  
Serghei Pisarenco ◽  
Iurie Simionica ◽  
◽  
...  
Keyword(s):  
Qt Interval ◽  
Torsade De Pointes ◽  
Qt Prolongation ◽  
Current Data ◽  
Polymorphic Ventricular Tachycardia ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Increased Risk ◽  
Wide Range ◽  
Life Threatening

QT interval prolongation is a predictor of the life-threatening cardiac arrhythmias — polymorphic ventricular tachycardia (torsade de pointes). Long QT syndrome may be congenital or acquired. It is known that a wide range of both antiarrhythmic and non-cardiac medications might lead to QT interval prolongation. List of drugs that cause QT prolongation is constantly growing and being updated. The review contains current data on the clinical significance of the control of QT interval duration within drug therapy. Clinical conditions associated with an increased risk of QT interval prolongation are described. Drugs that can induce QT prolongation are also discussed.

scholarly journals Acquired Long QT Syndrome: A Review of the Literature

2020 ◽  
Vol 3 (1) ◽  
pp. 67-70
Author(s):  
Rajendram R
Keyword(s):  
Cardiac Arrest ◽  
Long Qt Syndrome ◽  
Qt Interval ◽  
Torsade De Pointes ◽  
Polymorphic Ventricular Tachycardia ◽  
Beta Blockade ◽  
Illustrative Case ◽  
Long Qt ◽  
Life Threatening ◽  
Qt Syndrome

The QT interval represents the duration of ventricular depolarization and repolarization. It is measured from the beginning of the QRS complex to the end of the T wave. Prolongation of the QT interval may be congenital or acquired. This increases the risk of polymorphic ventricular tachycardia (i.e torsades de pointes) and cardiac arrest. To increase the awareness of this life-threatening phenomenon I outline an illustrative case in which acquired prolongation of the QT interval due to electrolyte derangement and administration of ciprofloxacin resulted in cardiac arrest due to torsade de pointes. Management of a patient with a long QT syndrome includes Immediate cessation of drugs that prolong the QT interval; cardiac monitoring, serial 12 lead ECGs and transthoracic echocardiography; measurement of serum electrolytes; intravenous potassium replacement; intravenous magnesium replacement; beta-blockade. Causes of acquired prolongation of the QT interval are common in critically ill patients. It is important to recognize this and consider screening with 12 lead ECG to reduce the risk of life-threatening ventricular arrhythmias.

Abstract TP203: New Onset Atrial Fibrillation Post Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Arezou Sadighi ◽  
Samantha Cherin ◽  
Rochelle Klutch ◽  
Sharon Craig ◽  
Fiona Chatfield ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Previous History ◽  
Female Gender ◽  
Final Diagnosis ◽  
Post Stroke ◽  
History Of ◽  
Artery Disease ◽  
Electrocardiogram Ecg ◽  
Onset Atrial Fibrillation ◽  
Prior Stroke

Background: Atrial fibrillation (AF) makes a person five times more likely to experience a stroke. According to the National Stroke Association, atrial fibrillation accounts for about 15 percent of stroke. Many of these patients do not have any previous history of AF, and are diagnosed with this condition post-stroke. We sought to characterize the frequency and features of AF in stroke patients hospitalized after acute presentation, focusing on new diagnoses. Methods: All subjects were enrolled in the Field Administration of Stroke Therapy- Magnesium (FAST-MAG) clinical trial, a phase 3 NIH-funded study of pre-hospital Magnesium Sulfate vs. placebo for patients with symptom onset <2hours. General demographic information, past medical history, first electrocardiogram (ECG) in the emergency department (ED), and final diagnosis data were collected on consecutive subjects. Results: Of 1478 patients, 69 (4.7%) had no previous history of AF but were diagnosed with AF post-stroke onset. There were 274 cases with AF recorded on the ED ECG (274), only 36 (13.1%) had no documented history of AF. Patients in both groups were of similar age (age 81 vs 79 years) and had similar rates of ICH diagnosis (8.7 vs 7.1%). However, newly diagnosed patients had more severe strokes (median NIHSS 14 vs 10, p=0.008) and a lower burden of cardiac disease by history (coronary artery disease 15.9 vs 31.7%, and myocardial infarction 5.8 vs 15.9%). Female gender women (50.7 vs 48.2%) history of prior stroke (10.1 vs 8.8%), hypertension (89.9 vs 89.5%), and hyperlipidemia (56.5 vs 54.1%) were similar in both groups. Conclusion: Most new diagnoses of AF after stroke were made based on the ED ECG. Strokes in patients who would go on to have new AF diagnoses were more severe than those where AF diagnosis was already established, likely due to less likelihood of anticoagulation.

scholarly journals Polymorphic Ventricular Tachycardia Associated with High-Dose Methadone Use

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
Weng-Chio Tam ◽  
U-Po Lam ◽  
Toi-Meng Mok ◽  
Tou Chang ◽  
Wa Ho ◽  
...  
Keyword(s):  
Qt Interval ◽  
Normal Limit ◽  
Torsade De Pointes ◽  
Qt Prolongation ◽  
Polymorphic Ventricular Tachycardia ◽  
High Dose ◽  
Cardiac Side Effects ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Artery Disease

Methadone is a well-tolerated drug that has been used for pain control and the treatment of opioid addiction. However, some fatal cardiac side effects have been reported previously, including ventricular arrhythmia, stress cardiomyopathy, and coronary artery disease. We reported a middle-aged woman receiving high-dose methadone whom was presented with QT prolongation and torsade de pointes. We replaced the methadone with benzodiazepine and gave lidocaine use simultaneously. Thus, QT interval was shortened within the normal limit. Methadone-induced torsade de pointes is a rare but serious event, and QT interval should be monitored periodically to prevent this fatal adverse event, especially some patients with high-dose methadone use.

scholarly journals Normal and abnormal QT interval duration and its changes in preadolescents and adolescents practicing sport

EP Europace ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. 1566-1574 ◽  
Author(s):  
Flavio D’Ascenzi ◽  
Francesca Anselmi ◽  
Francesca Graziano ◽  
Beatrice Berti ◽  
Andrea Franchini ◽  
...  
Keyword(s):  
Qt Interval ◽  
Qtc Interval ◽  
Interval Duration ◽  
Prospective Longitudinal Study ◽  
Repolarization Phase ◽  
Life Threatening ◽  
Qt Interval Duration ◽  
Electrocardiogram Ecg ◽  
Prospective Longitudinal

Abstract Aims Twelve-lead electrocardiogram (ECG) is an established tool in the evaluation of athletes, providing information about life-threatening cardiovascular diseases, such as long QT syndrome. However, the interpretation of ECG is sometimes challenging in children, particularly for the repolarization phase. The aim of this prospective, longitudinal study was to determinate the distribution of QT interval in children practicing sport and to evaluate changes in QT duration overtime. Methods and results A population of 1473 preadolescents practising sport (12.0 ± 1.8 years, 7–15 years) was analysed. Each athlete was evaluated at baseline, mid-term, and end of the study (mean follow-up: 3 ± 1 years). QT interval was corrected with Bazett (B) and Fridericia (F) formulae. At baseline QT interval corrected with the Bazett formula (QTcB) was 412 ± 25 ms and QT interval corrected with the Fridericia formula (QTcF) 387 ± 21 ms, with no changes during follow-up. Ten children (0.68%) had an abnormal QTc. In those with QTcB and QTcF ≥480 ms, QTc duration persisted abnormal during the follow-up and they were disqualified. Conversely, children with 460 ms < (QTcB) <480 ms had a normal QTc interval at the end of the study. These children had also a normal QTcF. Mean difference in the calculation of QT between the two formulae was 25 ± 11 ms (P < 0.0001). For resting heart rate (HR) ≥82 b.p.m., QTcF was independent from HR contrary to QTcB. Conclusion Normal QTc interval does not change over time in preadolescents. A minority of them has a QTc ≥480 ms; in these subjects, QTc interval remains prolonged. The use of Bazett and Fridericia correction formulae is not interchangeable and the Fridericia correction should be preferred in preadolescents with a resting HR ≥82 b.p.m.

Efavirenz-Associated QT Prolongation and Torsade de Pointes Arrhythmia

2002 ◽  
Vol 36 (6) ◽  
pp. 1006-1008 ◽  
Author(s):  
Ricardo Castillo ◽  
Ronald P Pedalino ◽  
Nabil El-Sherif ◽  
Gioia Turitto
Keyword(s):  
Torsade De Pointes ◽  
Transcriptase Inhibitor ◽  
Qt Prolongation ◽  
Clinical Event ◽  
Polymorphic Ventricular Tachycardia ◽  
Nonnucleoside Reverse Transcriptase Inhibitor ◽  
Acquired Long Qt Syndrome ◽  
Adverse Clinical Event ◽  
Life Threatening ◽  
Reverse Transcriptase Inhibitor

OBJECTIVE: To report a case of acquired long QT syndrome that, after exclusion of all other possible causes, was probably related to therapy with efavirenz, a novel nonnucleoside reverse transcriptase inhibitor. CASE SUMMARY: This patient presented with recurrent syncope and polymorphic ventricular tachycardia, which was treated with overdrive ventricular pacing and was eliminated by discontinuation of the offending drug. DISCUSSION: This is the first reported case of QT prolongation and severe ventricular arrhythmia associated with the use of efavirenz. The temporal relationship between the initiation of treatment and the onset of electrocardiographic abnormalities, the absence of other apparent precipitating factors, as well as the normalization of QT interval and the resolution of the arrhythmia after discontinuation of the drug, strongly suggest a causal relationship between efavirenz and this adverse clinical event. CONCLUSIONS: Our case shows that any new pharmaceutical compound introduced in clinical practice may potentially result in QT prolongation and life-threatening arrhythmia.

Sign in / Sign up

Export Citation Format

Share Document