Medicolegal Problems in the Management of Cardiac Arrhythmias in Children

PEDIATRICS ◽  
1987 ◽  
Vol 79 (1) ◽  
pp. 84-88
Author(s):  
Arthur Garson
Keyword(s):  
Ventricular Tachycardia ◽  
Sudden Death ◽  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Long Qt ◽  
Seizure Disorders ◽  
Long Qt Interval ◽  
Potential Problems ◽  
Optimal Medical Management ◽  
Medicolegal Problems

Malpractice actions against pediatricians treating patients with arrhythmias have been recurrent in four general areas. Optimal medical management may not be widely recognized. Cases illustrating the following concepts are presented. (1) Intravenous verapamil therapy in babies may cause apnea, hypotension, and bradycardia; (2) continued episodes of atrial flutter in a child may cause sudden death; quinidine may be related to the death; (3) children with "familial seizure disorders" may in fact have the long QT interval syndrome. The QT interval must be measured on the ECG in patients with unexplained seizures; (4) "supraventricular tachycardia with aberration" is uncommon in children. Rapid heart rates with QRS complexes that are different from the sinus complexes are likely to be ventricular tachycardia. These situations must be recognized as potential problems and must be treated appropriately.

scholarly journals Diagnosis of congenital long QT interval syndrome in a 16-year old girl

2021 ◽  
pp. 126-130
Author(s):  
N. A. Skuratova ◽  
A. I. Zaryankina ◽  
A. A. Kozlovsky ◽  
S. S. Ivkina
Keyword(s):  
Ventricular Tachycardia ◽  
Sudden Death ◽  
Qt Interval ◽  
Clinical Case ◽  
Clinical Manifestations ◽  
Cardiac Pacemaker ◽  
Long Qt ◽  
Long Qt Interval ◽  
Prolonged Qt Interval ◽  
Prolonged Qt

The article presents a clinical case of a 16-year-old girl with clinical manifestations of congenital long QT interval syndrome in the form of syncope which were primarily diagnosed as epileptic syndrome for which the patient was taking anticonvulsant drugs having qualities of secondary prolongation of QT interval. At the same time, the data of family anamnesis (sudden death of the mother at a young age) in combination with typical manifestations of disease and electrocardiographic signs (prolonged QT interval measured from the standard electrocardiogram, paroxysms of spindle-shaped ventricular tachycardia accompanied with syncope conditions) made it possible to diagnose congenital long QT interval syndrome and implant an electric cardiac pacemaker.

Polymorphic ventricular tachycardia, ischaemic ventricular fibrillation, and torsade de pointes: importance of the QT and the coupling interval in the differential diagnosis

2021 ◽  
Author(s):  
Raphael Rosso ◽  
Aviram Hochstadt ◽  
Dana Viskin ◽  
Ehud Chorin ◽  
Arie Lorin Schwartz ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Qt Interval ◽  
Torsade De Pointes ◽  
Polymorphic Ventricular Tachycardia ◽  
Ectopic Beat ◽  
Long Qt ◽  
Drug Induced ◽  
Long Qt Interval ◽  
Coupling Interval

Abstract Aims Distinctive types of polymorphic ventricular tachycardia (VT) respond differently to different forms of therapy. We therefore performed the present study to define the electrocardiographic characteristics of different forms of polymorphic VT. Methods and results We studied 190 patients for whom the onset of 305 polymorphic VT events was available. The study group included 87 patients with coronary artery disease who had spontaneous polymorphic VT triggered by short-coupled extrasystoles in the absence of myocardial ischaemia. This group included 32 patients who had a long QT interval but nevertheless had their polymorphic VT triggered by ectopic beats with short coupling interval, a subcategory termed ‘pseudo-torsade de pointes] (TdP). For comparison, we included 50 patients who had ventricular fibrillation (VF) during acute myocardial infarction (‘ischaemic VF’ group) and 53 patients with drug-induced TdP (‘true TdP’ group). The QT of patients with pseudo-TdP was (by definition) longer than that of patients with polymorphic VT and normal QT (QTc 491.4 ± 25.2 ms vs. 447.3 ± 55.6 ms, P < 0.001). However, their QT was significantly shorter than that of patients with true TdP (QTc 564.6 ± 75.6 ms, P < 0.001). Importantly, the coupling interval of the ectopic beat triggering the arrhythmia was just as short during pseudo-TdP as during polymorphic VT with normal QT (359.1 ± 38.1 ms vs. 356.6 ± 39.4 ms, P = 0.467) but was much shorter than during true TdP (581.2 ± 95.3 ms, P < 0.001). Conclusions The coupling interval helps discriminate between polymorphic VT that occurs despite a long QT interval (pseudo-TdP) and polymorphic arrhythmias striking because of a long QT (true TdP).

Epicardial activation patterns of torsade de pointes in canine hearts with quinidine-induced long QT interval but without myocardial infarction

1986 ◽  
Vol 111 (6) ◽  
pp. 1080-1087 ◽  
Author(s):  
Hiroshi Inoue ◽  
Yuji Murakawa ◽  
Iku Toda ◽  
Akira Nozaki ◽  
Hiroshi Matsuo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Qt Interval ◽  
Torsade De Pointes ◽  
Long Qt ◽  
Activation Patterns ◽  
Long Qt Interval

scholarly journals Drug-induced long qt syndrome

2020 ◽  
Vol 27 (3) ◽  
pp. 42-52
Author(s):  
G. A. Golovina ◽  
K. V. Zaphiraki ◽  
E. D. Kosmacheva
Keyword(s):  
Long Qt Syndrome ◽  
Qt Interval ◽  
Diagnosis And Treatment ◽  
Fatal Complication ◽  
Long Qt ◽  
Drug Induced ◽  
Long Qt Interval ◽  
Qt Syndrome

In this review drug-induced long QT interval syndrome is described. The authors discuss approaches for the prevention, diagnosis, and treatment of this potentially fatal complication.

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