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 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.

Persistent Trigeminal Artery as a Cause of Dizziness

1997 ◽  
Vol 76 (1) ◽  
pp. 43-45 ◽  
Author(s):  
Robert A. Battista ◽  
Jed A. Kwartler ◽  
Daniel M. Martinez
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Persistent Trigeminal Artery ◽  
Vertebrobasilar Insufficiency ◽  
Trigeminal Artery ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Common Problems ◽  
Artery Disease

Complaints of vertigo and dizziness are common problems referred to otolaryngologists for evaluation. Awareness of uncommon causes of dizziness increases the physician's ability to diagnose and treat these patients. We present the case of a middle-aged woman who presented with episodes of vertigo and symptoms suggestive of vertebrobasilar insufficiency. These symptoms were the result of a persistent trigeminal artery (PTA) and occlusive carotid artery disease. A PTA is a carotid-basilar anastomosis that has been reported to be demonstrated on 0.1% to 0.6% of all cerebral angiograms. Persistence of this vessel usually leads to hypoplasia or agenesis of the ipsilateral posterior communicating artery, and leaves the internal carotid artery as the main source of blood supply to the region of the upper brainstem. The appearance and clinical significance of this unusual condition will be discussed.

scholarly journals Prolonged QT Interval in a Patient With Coronavirus Disease-2019: Beyond Hydroxychloroquine and Azithromycin

2020 ◽  
Vol 8 ◽  
pp. 232470962094840
Author(s):  
B K Anupama ◽  
Soumya Adhikari ◽  
Debanik Chaudhuri
Keyword(s):  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Torsade De Pointes ◽  
Cardiac Pacing ◽  
Qt Prolongation ◽  
Medication Effects ◽  
Increased Risk ◽  
Repolarization Reserve ◽  
Prolonged Qt Interval ◽  
Prolonged Qt

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.

scholarly journals QT Prolongation and Associated Ventricular Tachycardia due to Cardiac Iron Load in a Patient with Thalassemia Major

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Derya Demirtas ◽  
Abdullah Orhan Demirtas ◽  
Hilmi Erdem Sumbul ◽  
Ayse Selcan Koc
Keyword(s):  
Ventricular Tachycardia ◽  
Qt Interval ◽  
Thalassemia Major ◽  
Qt Prolongation ◽  
High Dose ◽  
Resonance Imaging ◽  
Long Qt ◽  
Blocker Therapy ◽  
Iron Load ◽  
Magnetic Resonance Imaging Mri

We report the case of a 23-year-old male with thalassemia major who developed long QT and continuous ventricular tachycardia (VT). Electrocardiography, echocardiography, and cardiac magnetic resonance imaging (MRI) were used for diagnosis and risk stratification. VT causes and treatments are presented and discussed. Ventricular arrhythmia can be treated by normalizing QT interval with high-dose beta-blocker therapy. However, MRI-compatible internal cardiac defibrillator implantation was performed due to the high risk in this patient.

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 A Middle-aged Woman Suffering Buerger’s Disease

2020 ◽  
Vol 1 (1) ◽  
pp. 6
Author(s):  
M. Aminuddin ◽  
Devie Caroline
Keyword(s):  
Doppler Ultrasound ◽  
Normal Limit ◽  
Partial Occlusion ◽  
Buerger’S Disease ◽  
Laboratory Examination ◽  
Buerger's Disease ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
The Right ◽  
Local Examination

A 48 years old woman complains of numbness on her fingers and toes. Her 4th and the 5th right fingertips were painful and then blackened. She had no diabetes and hypertension history. She didn’t smoke, but her husband and son were smokers. On local examination there were necrotic gangrenes on the 4th and the 5th fingertips of the right hand. Laboratory examination results (including immunology marker) were within normal limit. Doppler ultrasound and arteriography showed segmental stenosis and partial occlusion of distal arteries on all extremities. We assessed the patient with Buerger’s disease. The managements were oral analgesic and vasodilator medication. Endoscopic thoracal ganglion sympathectomy was performed, followed by amputation of the necrotic fingers. We did not perform a biopsy, so according to all examinations and also by Shionoya and Olin’s criteria, the patient was more likely to suffer from Buerger’s disease than other peripheral occlusive diseases.

scholarly journals Managing QT prolongation in the Era of Coronavirus Disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Sidhi Laksono Purwowiyoto ◽  
Dony Yugo Hermanto ◽  
Muhammad Iqbal
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Drug Interactions ◽  
Clinical Outcomes ◽  
Qt Interval ◽  
Metabolic Disorders ◽  
Torsade De Pointes ◽  
Qt Prolongation ◽  
Multiorgan Dysfunction ◽  
Know How ◽  
Critical Patients

Indonesia has declared a COVID-19 outbreaks because of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in March 2020. COVID-19 has significantly increased morbidity and mortality worldwide. Some studies have shown good clinical outcomes with the use of combination of chloroquine or hydroxychloroquine and azithromycin. That drugs can prolong the QT interval and increase the risk of Torsade de Pointes (TdP). The risk is increasing in several conditions such as in critical patients, metabolic disorders, sepsis, multiorgan dysfunction and with drug-drug interactions. Cardiologists need to know how to manage this condition to reduce the risk of TdP.

Atypical neuroleptic malignant syndrome and non-alcoholic Wernicke’s encephalopathy

2021 ◽  
Vol 14 (8) ◽  
pp. e244082
Author(s):  
Esther Shan Lin Hor ◽  
Gurpreet Pal Singh ◽  
Nurul Akhmar Omar ◽  
Vincent Russell
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Kidney Injury ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
High Dose ◽  
Fluphenazine Decanoate ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Atypical Presentations ◽  
High Index Of Suspicion

We report the case of a middle-aged woman with a history of bipolar disorder, in the absence of alcohol or substance misuse. The patient had been maintained on fluphenazine decanoate depot and now presented acutely with cognitive dysfunction and rigidity. Laboratory tests revealed elevated creatine kinase, acute kidney injury with metabolic acidosis and transaminitis, leading to a provisional diagnosis of neuroleptic malignant syndrome (NMS). Neuroleptics were withheld; dialysis was commenced; and blood biochemistry parameters improved in tandem. However, mental status changes persisted, and re-evaluation revealed multidirectional nystagmus with bilateral past-pointing. MRI confirmed the diagnosis of Wernicke’s encephalopathy (WE). Prompt recovery followed treatment with high-dose intravenous thiamine. We discuss the co-occurrence of NMS and non-alcoholic WE—highlighting the need for a high index of suspicion for these relatively rare neuropsychiatric diagnoses which are often missed in those with atypical presentations.

scholarly journals Sudden cardiac death and antipsychotics. Part 1: Risk factors and mechanisms

2006 ◽  
Vol 12 (1) ◽  
pp. 35-44 ◽  
Author(s):  
Nasser Abdelmawla ◽  
Alex J. Mitchell
Keyword(s):  
Cardiac Disease ◽  
Qt Interval ◽  
Torsade De Pointes ◽  
High Dose ◽  
Qtc Interval ◽  
Clear Explanation ◽  
Increased Risk ◽  
Approximate Relationship ◽  
Mental Health Difficulties ◽  
Therapeutic Doses

Mortality from causes other than suicide is higher than expected in schizophrenia. Cardiovascular causes are most common, accounting for the majority of the 5% of sudden and unexpected deaths. Most cases have no clear explanation on post-mortem examination (‘sudden unexplained deaths’) and are thought to result from fatal arrhythmias. Prospective studies show that people with prolongation of the QT interval beyond 500 ms are at increased risk of serious arrhythmias such as ventricular tachycardia and torsade de pointes. In about 1 in 10 cases, the torsade is fatal. Most antipsychotics prolong the QTc interval in overdose but some prolong it even at therapeutic doses. Droperidol, sertindole and ziprasidone extend the QT interval by an average of 15–35 ms; quetiapine, haloperidol and olanzapine by 5 ms, to 15 ms. There is only an approximate relationship between QT prolongation and risk of sudden death, and the risk related to antipsychotics is thought to increase in people with pre-existing cardiac disease, those taking multiple QT-acting drugs and those taking antipsychotics at high dose for long periods. There is little evidence of an association with route of administration. More data are required to clarify to what extent people with mental health difficulties who die suddenly have pre-existing cardiac disease.

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