prolonged qt interval
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Author(s):  
Varsha Gajbhiye ◽  
Shubhangi Patil ◽  
Sarika Gaikwad ◽  
Sushma Myadam

Dilated cardiomyopathy (DCM) is known to have ventricular dilatation and dysfunction in  myocardium. Primary carnitine deficiency (PCD) is a not common but a reversible autosomal recessive phenomenon with supplementation of carnitine. Case presentation- 11-month male child was brought with complain of fever, cough, cold since 7 days and increased work of breathing for 15 days.  2 D echo was done suggestive of dilated cardiomyopathy. His initial investigations; chest Xray revealed significant cardiomegaly electrocardiography, (ECG) showed prolonged QT interval fraction. Patient was treated with syrup carnitine syrup empirically, as there is no way to determine a fatty acid oxidation profile. Repeated 2D echocardiogram (2 D ECHO) was suggestive of recovery. Conclusions: Carnitine deficiency could be the cause of  cardiomyopathy and so treatment of carnitine supplementation can be considered empirically to avoid life-threatening complication related to cardiomyopathy.


2021 ◽  
pp. 55-61
Author(s):  
О.B. Synoverska ◽  
◽  
Yu.I. Alekseeva ◽  
N.M. Fomenko ◽  
M.Y. Rеitmаier ◽  
...  

The article provides basic information about the syndrome of prolonged QT interval, which is a rare pathology of the cardiovascular system and can cause sudden death. The mutations in the genes responsible for dysfunction of ion channels are the key in the pathogenesis of this disease. Jerwell and Lange—Nielsen, Romano—Ward, Andersen—Tavil and Timothy syndromes are described as the main hereditary variants of this syndrome. A own case of the disease in a patient was given. The peculiarity of this case was on the acute, atypical onset of the disease, which started with convulsions and sudden cardiac death. The clinical picture of this case, features of a current are described, indicators of the basic methods of research are resulted. Information on the treatment of this clinical case at the local level and in the department of surgical treatment of arrhythmias, where the patient underwent implantation of endocardial bicameral cardioverter-defibrillator, іs presented. Data on further observation and treatment of the child at the place of residence are given. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: syndrome, QT interval, etiology, pathogenesis, clinical picture, diagnosis, examination, treatment.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tara V. Anand ◽  
Brendan K. Wallace ◽  
Herbert S. Chase

Abstract Background It has been hypothesized that polypharmacy may increase the frequency of multidrug interactions (MDIs) where one drug interacts with two or more other drugs, amplifying the risk of associated adverse drug events (ADEs). The main objective of this study was to determine the prevalence of MDIs in medication lists of elderly ambulatory patients and to identify the medications most commonly involved in MDIs that amplify the risk of ADEs. Methods Medication lists stored in the electronic health record (EHR) of 6,545 outpatients ≥60 years old were extracted from the enterprise data warehouse. Network analysis identified patients with three or more interacting medications from their medication lists. Potentially harmful interactions were identified from the enterprise drug-drug interaction alerting system. MDIs were considered to amplify the risk if interactions could increase the probability of ADEs. Results MDIs were identified in 1.3 % of the medication lists, the majority of which involved three interacting drugs (75.6 %) while the remainder involved four (15.6 %) or five or more (8.9 %) interacting drugs. The average number of medications on the lists was 3.1 ± 2.3 in patients with no drug interactions and 8.6 ± 3.4 in patients with MDIs. The prevalence of MDIs on medication lists was greater than 10 % in patients prescribed bupropion, tramadol, trazodone, cyclobenzaprine, fluoxetine, ondansetron, or quetiapine and greater than 20 % in patients prescribed amiodarone or methotrexate. All MDIs were potentially risk-amplifying due to pharmacodynamic interactions, where three or more medications were associated with the same ADE, or pharmacokinetic, where two or more drugs reduced the metabolism of a third drug. The most common drugs involved in MDIs were psychotropic, comprising 35.1 % of all drugs involved. The most common serious potential ADEs associated with the interactions were serotonin syndrome, seizures, prolonged QT interval and bleeding. Conclusions An identifiable number of medications, the majority of which are psychotropic, may be involved in MDIs in elderly ambulatory patients which may amplify the risk of serious ADEs. To mitigate the risk, providers will need to pay special attention to the overlapping drug-drug interactions which result in MDIs.


2021 ◽  
pp. 85-90
Author(s):  
Abdalla Khalil ◽  
Jithesh Choyi ◽  
Khalil Hossenbux ◽  
Ahmed Taha

Hypomagnesemia is one of the electrolyte disturbances that can cause seizures. It is common in the hospitalized patients and can be induced by long-term usage of many medications. A 68-year-old male known to have hypertension and gastroesophageal reflux presented to the Emergency Department with an unprovoked first seizure at home followed by a temporary right-sided hemiparesis, dysphasia, and facial asymmetry. The hemiparesis, dysphasia, and facial asymmetry resolved within less than an hour after the seizure. His serum potassium was low with prolonged QT interval in the electrocardiogram (serum magnesium was not checked in the Emergency Department). He received intravenous IV potassium chloride infusion, and his serum potassium level was corrected, but he had a recurrent seizure after 10 h. At that time, his serum magnesium was found to be very low, he received IV magnesium sulfate infusion, and his indapamide, omeprazole, and metformin medications were stopped. He had no further seizures, the rest of his blood tests were normal, and his CT brain was unremarkable. He was treated for aspiration pneumonia, and his outpatient MRI brain and EEG came to be normal too.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Ken Shimano ◽  
Kyungho Chang ◽  
Yoshiki Hara ◽  
Atsushi Yasuda ◽  
Shigehito Sawamura

Abstract Background Several types of antiarrhythmic drugs are known to induce QT prolongation and torsades de pointes. Case presentation An 84-year-old man was scheduled for open gastrectomy for residual cancer. He had been prescribed bepridil for atrial fibrillation that converted to sinus rhythm with prolonged QT interval in the operating room. After the surgery was initiated under general and epidural anesthesia, the patient’s heart rate decreased to 50/min and multifocal premature ventricular contractions appeared, followed by several episodes of torsades de pointes, each lasting for 5 to 15 s. Infusion of isoproterenol was started (0.01 μg/kg/min), and the heart rate was maintained at around 80/min. Premature ventricular contractions disappeared, and torsades de pointes did not recur during the surgery. The operation was completed uneventfully. The serum bepridil concentration was found to be extremely high postoperatively. Conclusions Bepridil-induced intraoperative episodes of torsades de pointes were successfully treated by increasing the heart rate with isoproterenol.


2021 ◽  
Vol 102 (5) ◽  
pp. 747-750
Author(s):  
Yu S Mishanina ◽  
V N Oslopov ◽  
Yu V Oslopova ◽  
Yu E Teregulov ◽  
E V Khazova

Using a clinical example, the article draws the attention of doctors to the problem of the prolonged QT interval (long QT) and the related problem of fainting (syncope). Syncope is a component of long QT syndrome, and syncope is a precursor of sudden cardiac death. However, syncope in a patient with long QT syndrome may have pathogenesis that is completely unrelated to abnormalities of cardiac ion channels. In other words, such a patient may have a second disease as a syntropy relates to prolonged QT interval, to an extent mimicking long QT syndrome. The presented medical history of a 33-year-old patient S. shows the complexity of differential diagnosis of the causes of syncope. The crucial part in the diagnosis, in addition to the clinical picture, was the so-called tilt test, little-known to general medical practice, as well as the laboriousness of making a final diagnosis of the long QT Syndrome type 2, which required a molecular genetic study whole-exome sequencing. Patient S. had vasovagal syncope that not associated with long QT syndrome, but she has a risk of sudden cardiac death, and the article identifies therapeutic and other measures to reduce this risk.


2021 ◽  
Vol 96 (5) ◽  
pp. 432-437
Author(s):  
Jinmo Kim ◽  
Ju Yeop Lee ◽  
Won Sang Yoo ◽  
Myung Yong Lee ◽  
Hyun-Kyung Chung

Diabetic ketoacidosis (DKA) is an acute complication related to severe hyperglycemia. While the mortality rate for DKA is low with appropriate therapy, several complications may lead to deterioration of the clinical course. Here, we report a case of a 23-year-old patient with DKA who suffered from a rare but hemodynamically unstable cardiac arrhythmia, polymorphic ventricular tachycardia with prolonged QT interval, or Torsades de Pointes. During the recovery phase of DKA, three episodes of Torsades de Pointes suddenly occurred, and were recovered by immediate defibrillation. The patient did not have structural heart disease or a genetic predisposition. To the best of our knowledge, this is the first report of an adult with DKA complicated with QT prolongation related to Torsades de Points after correction of ketosis. To manage DKA, more attention may be needed on changes in the QT interval as well as risk factors for Torsades de Points.


2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110470
Author(s):  
Hang Gong ◽  
Xianli Liu ◽  
Fang Cheng

Objective We performed a meta-analysis to create a quantitative estimate of the association between non-alcoholic fatty liver disease (NAFLD) and the risk of cardiac arrhythmia (including atrial fibrillation (AF), prolonged QT interval, premature atrial/ventricular contraction [PAC/PVC] and heart block). Methods A literature review was conducted using PubMed, Embase, Web of Science and the Cochrane Library database to identify observational studies of the link between NAFLD and cardiac arrhythmia. Effect sizes were expressed as odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs). The method of analysis of AF was also analysed separately, according to the effect estimate (OR or HR). Results Nineteen studies of 7,012,960 individuals were included. NAFLD was independently associated with higher risks of AF (OR 1.71, 95% CI: 1.14–2.57; HR 1.12, 95% CI: 1.11–1.13), prolonged QT interval (OR 2.86, 95% CI: 1.64–4.99), PAC/PVC (OR 2.53, 95% CI: 1.70–3.78) and heart block (OR 2.65, 95% CI: 1.88–3.72). The heterogeneity of the data with respect to AF and prolonged QT was moderate on sensitivity analysis. Conclusions We found a significantly higher risk of cardiac arrhythmia in patients with NAFLD, but the observational design of the studies does not permit conclusions regarding causality.


2021 ◽  
Vol 5 (4) ◽  
pp. 971-977
Author(s):  
Sugianto Mukmin ◽  
Erwin Sukandi ◽  
Abarham Martadiansyah

Backgrounds. Supraventricular tachycardia is a type of tachyarrhythmia characterized by sudden changes in heart rate and increases rapidly. In supraventricular tachycardia, the abnormalities that occur include components of the conduction system and occur in the upper part of the HIS bundle. This case report describes a case of supraventricular tachycardia suspected of AVNRT in a pregnant woman accompanied by hypokalemia, hypocalcemia and prolonged QT Interval along with cardioversion which was performed as the management of this case.Case presentation. A woman, Mrs Y, 24 years old, a housewife, having her address within the city of Palembang. The patient came to the emergency department of Moh. Hoesin Hospital Palembang with the chief complaint of chest palpitations. On physical examination, there was a grade 2/6 murmur, no shortness of breath, the patient was 7 months pregnant. He had a history of heart disease SVT 8 years ago. ECG examination showed sinus rhythm with low atrial rhythm in leads II, III, AVF. On laboratory examination, the blood calcium level was 8.3 mg/dL. Management of this patient includes pharmacological and non-pharmacological management. On the 14th day of hospitalization, 100 joules of cardioversion was performed and the patient responded well. The patient's condition improved on the 20th day of treatment.Conclusion. The patient experienced a good and effective response to 100 joules of cardioversion which was performed on the 14th day of treatment. Maintenance treatment in the form of drugs in the form of diltiazem due to the condition of the patient who is 27 weeks pregnant. The next management is planning the birth process according to the patient's hemodynamics and preventing the occurrence of SVT in subsequent pregnancies.


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