prolonged qt
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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 ◽  
Vol 30 (6) ◽  
pp. 466-470
Author(s):  
Enrique Calvo-Ayala ◽  
Vince Procopio ◽  
Hayk Papukhyan ◽  
Girish B. Nair

Background QT prolongation increases the risk of ventricular arrhythmia and is common among critically ill patients. The gold standard for QT measurement is electrocardiography. Automated measurement of corrected QT (QTc) by cardiac telemetry has been developed, but this method has not been compared with electrocardiography in critically ill patients. Objective To compare the diagnostic performance of QTc values obtained with cardiac telemetry versus electrocardiography. Methods This prospective observational study included patients admitted to intensive care who had an electrocardiogram ordered simultaneously with cardiac telemetry. Demographic data and QTc determined by electrocardiography and telemetry were recorded. Bland-Altman analysis was done, and correlation coefficient and receiver operating characteristic (ROC) coefficient were calculated. Results Fifty-one data points were obtained from 43 patients (65% men). Bland-Altman analysis revealed poor agreement between telemetry and electrocardiography and evidence of fixed and proportional bias. Area under the ROC curve for QTc determined by telemetry was 0.9 (P < .001) for a definition of prolonged QT as QTc ≥ 450 milliseconds in electrocardiography (sensitivity, 88.89%; specificity, 83.33%; cutoff of 464 milliseconds used). Correlation between the 2 methods was only moderate (r = 0.6, P < .001). Conclusions QTc determination by telemetry has poor agreement and moderate correlation with electrocardiography. However, telemetry has an acceptable area under the curve in ROC analysis with tolerable sensitivity and specificity depending on the cutoff used to define prolonged QT. Cardiac telemetry should be used with caution in critically ill patients.


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 ◽  
pp. 1-3
Author(s):  
Emrah Erdogan ◽  
Murat Cap ◽  
Gorkem Kus ◽  
Cem Gokhan ◽  
Yakup Kilic

Abstract Allergic reactions related to drug use is a common entity presenting often from minor urticaria to life-threatening anaphylactoid reactions. A common but easily overlooked diagnosis, Kounis syndrome, is an established hypersensitivity coronary disorder induced by drugs, foods, environmental factors, and coronary stents that can present in the same way as non-allergy-induced acute coronary syndrome. Here within, we present a unique case of dual presentation of Kounis syndrome and prolonged QTc in a young patient after a single dose of Domperidone and Lansoprazole.


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 14 (7) ◽  
pp. e243325
Author(s):  
Sameen Iqbal ◽  
Sidra Malik Fayyaz ◽  
Yawer Saeed ◽  
Masooma Aqeel

A young man presented to the emergency department with seizures and recurrent episodes of polymorphic ventricular tachycardia (PMVT)/torsades de pointes (TdP) requiring cardioversion and administration of intravenous magnesium. A battery of tests performed to identify a cause for his arrhythmias and seizures were all normal. A revisit of history with family revealed he had consumed over 100 tablets/day of loperamide for the past 1 year. A prolonged QT interval on his ECG raised concerns for long QT syndrome (LQTS) (congenital or acquired). Our patient was suspected to have loperamide-induced cardiotoxicity. TdP is a specific PMVT that occurs with a prolonged QT interval and is usually drug-induced. Less frequently, congenital LQTS may be implicated. With supportive care, including mechanical ventilation, vasopressors and temporary transvenous overdrive pacing, our patient recovered completely. We describe the importance of a systematic and time-sensitive approach to diagnosing critical illness. Loperamide overdose may cause QT prolongation, life-threatening arrhythmias/cardiogenic shock, or cardiac arrest. Seizures/epilepsy may also be a manifestation in young patients. There is a substantial need to revisit the safety of over-the-counter medications and increasing awareness of manifestations of drug overdose.


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