scholarly journals A case of hypoglycemiainduced QT prolongation leading to torsade de pointes and a review of pathophysiological mechanisms

2017 ◽  
Vol 7 (3) ◽  
Author(s):  
Faris Hannoodi ◽  
Hashim Alwash ◽  
Kushal Shah ◽  
Israa Ali ◽  
Sarwan Kumar ◽  
...  
Keyword(s):  
Torsade De Pointes ◽  
Torsades De Pointes ◽  
Serum Glucose ◽  
Interesting Case ◽  
Qt Prolongation ◽  
Calcium Oscillations ◽  
Calcium Overload ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Life Threatening

<em>Torsades de pointes</em> is a life-threatening cardiac arrhythmia. Occurrence of this arrhythmia as a result of hypoglycemia has not been reported in the literature. We describe an interesting case of an insulindependent diabetic patient presenting with torsades de pointes resulting from hypoglycemia. A 62-year-old male was admitted to the hospital following an episode of severe insulin-induced hypoglycemia and a cardiac arrest. He was found to unresponsive at home after taking insulin. His serum glucose was found to be 18. He was given juice initially to normalize his glucose and was then transferred by EMS to ER where he was given 5% dextrose infusion. Analysis of the LifeVest rhythm recording showed torsades de pointes that was terminated by defibrillation of the LifeVest. Several mechanisms are responsible for torsade, including QT interval prolongation, adrenalin secretion and calcium overload leading to intracellular calcium oscillations. These mechanisms are a trigger to torsade de pointes. Predisposing factors were present leading torsade to occur.

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 Fluconazole-associated QT interval prolongation and Torsades de Pointes in a paediatric patient

2021 ◽  
pp. 1-3
Author(s):  
Ayşe Ünal Yüksekgönül ◽  
İlker Ertuğrul ◽  
Tevfik Karagöz
Keyword(s):  
Qt Interval ◽  
Torsades De Pointes ◽  
Qt Prolongation ◽  
Polymorphic Ventricular Tachycardia ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Life Threatening ◽  
Prolonged Qt Interval ◽  
Rhythm Disorder ◽  
Anti Fungal

Abstract “Torsades de pointes”, a life-threatening rhythm disorder, is a polymorphic ventricular tachycardia that usually develops in association with a prolonged QT interval. Fluconazole, an anti-fungal drug, may also induce QT prolongation, in some cases subsequent torsades de pointes. Herein, we report a 16-year-old female presenting “torsades de pointes” after administration of fluconazole and rapidly improved upon cessation of the drug.

scholarly journals Postoperative QT Interval Prolongation in Patients Undergoing Noncardiac Surgery under General Anesthesia

2012 ◽  
Vol 117 (2) ◽  
pp. 321-328 ◽  
Author(s):  
Peter Nagele ◽  
Swatilika Pal ◽  
Frank Brown ◽  
Jane Blood ◽  
J. Philipp Miller ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Qt Interval ◽  
Serum Magnesium ◽  
Torsades De Pointes ◽  
Noncardiac Surgery ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Life Threatening ◽  
Qt Interval Duration

Background Abnormal cardiac repolarization, indicated by a prolongation of the QT interval, increases the risk for torsades de pointes, a potentially life-threatening arrhythmia. Many perioperatively administered drugs and conditions prolong the QT interval. Despite several reports of perioperative torsades de pointes, systematic evidence regarding perioperative QT interval prolongation is limited. Methods Serial postoperative 12-lead electrocardiograms were obtained from 469 adult patients undergoing major noncardiac surgery under general anesthesia. Heart rate corrected QT-interval duration (Fridericia formula) was the primary outcome. All perioperatively administered drugs were recorded. Emphasis was placed on absolute QTc prolongation greater than 500 ms and relative increases of 30 and 60 ms. Results At the end of surgery, 80% of the patients (345 of 429) experienced a significant QTc interval prolongation (ΔQTc 23 ± 26 ms (mean and SD), 95% CI 20-25 ms, P less than 0.001). Approximately 51% (219 of 429) had a QTc greater than 440 ms, and 4% (16 of 429) a QTc greater than 500 ms. In 39% (166 of 429), the ΔQTc was greater than 30 ms, in 8% (34 of 429) &gt;60 ms, and in greater than 0.5% (2 of 429) &gt;100 ms. No changes in ΔQTc occurred at subsequent time points. One patient developed torsades de pointes with a ΔQTc: 29 ms (0.4% incidence rate). Several drugs had a large effect on ΔQTc: isoflurane, methadone, ketorolac, cefoxitin, zosyn, unasyn, epinephrine, ephedrine, and calcium. Postoperative body temperature had a weak negative correlation with ΔQTc (r = -0.15, P = 0.02); serum magnesium, potassium, and calcium concentrations were not correlated. Conclusion Postoperative QT-interval prolongation is common. Several perioperatively administered drugs are associated with a substantial QT-interval prolongation. The exact cause and its clinical relevance are, however, unclear. Nevertheless, an association between postoperative QT prolongation and risk for torsades de pointes is likely.

scholarly journals Risk of QT Prolongation through Drug-drug Interactions between Hydroxychloroquine and Concomitant Drugs Prescribed in Real-world Practice

2020 ◽  
Author(s):  
Byung Jin Choi ◽  
Yeryung Koo ◽  
Tae Young Kim ◽  
Wou Young Chung ◽  
Yun Jung Jung ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Real World ◽  
Qt Interval ◽  
Qt Prolongation ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Life Threatening ◽  
Alternative Drugs

Abstract Background: Hydroxychloroquine has recently received attention as a treatment for COVID-19. However, hydroxychloroquine may prolong the QTc interval, thus increasing the risk of life-threatening arrhythmia. Many patients with COVID-19 have comorbidities, necessitating the use of several drugs simultaneously with hydroxychloroquine. However, the risk of QT prolongation due to drug-drug interactions (DDIs) between hydroxychloroquine and these co-medications has not been identified. Therefore, it is necessary to investigate the risk of QT interval prolongation due to DDIs between hydroxychloroquine and frequently used concurrent drugs.Methods and Results: Using 447,632 patients and 1,040,752 electrocardiograms, we investigated the risk of QT prolongation due to DDIs between hydroxychloroquine and 118 concurrent drugs frequently used in real-world practice. In the analysis, we observed that 11 drugs (trimebutine, tacrolimus, tramadol, rosuvastatin, ciclosporin, sulfasalazine, rofecoxib, diltiazem, piperacillin/tazobactam, and isoniazid) show DDIs with hydroxychloroquine in the direction of QT prolongation.Conclusions: We found 11 drugs that show significant (p <0.05) DDIs with hydroxychloroquine, thereby increasing the risk of QT prolongation in patients. It is necessary to consider prescribing alternative drugs that have less DDI when these drugs are concurrently administered with hydroxychloroquine. Further investigation is needed to assess more profoundly the risk of QT prolongation due to DDI with hydroxychloroquine of each drug that we found in this analysis.

scholarly journals QT Interval Prolongation and Torsade De Pointes in Patients with COVID-19 treated with Hydroxychloroquine/Azithromycin

2020 ◽  
Author(s):  
Ehud Chorin ◽  
Lalit Wadhwani ◽  
Silvia Magnani ◽  
Matthew Dai ◽  
Eric Shulman ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Qt Interval ◽  
Potential Benefit ◽  
Drug Exposure ◽  
Torsade De Pointes ◽  
Careful Consideration ◽  
Qt Prolongation ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Qt Interval Prolongation

AbstractBackgroundThe emergence of the COVID-19 pandemic has resulted in over two million affected and over 150 thousand deaths to date. There is no known effective therapy for the disease. Initial reports suggesting the potential benefit of Hydroxychloroquine/Azithromycin (HY/AZ) have resulted in massive adoption of this combination worldwide. However, while the true efficacy of this regimen is unknown, initial reports have raised concerns regarding the potential risk of QT prolongation and induction of torsade de pointes (TdP).MethodsThis is a multicenter retrospective study of 251 patients with COVID-19 treated with HY/AZ. We reviewed ECG tracings from baseline and until 3 days after completion of therapy to determine the progression of QTc and incidence of arrhythmia and mortality.ResultsQTc prolonged in parallel with increasing drug exposure and incompletely shortened after its completion. Extreme new QTc prolongation to > 500 ms, a known marker of high risk for TdP had developed in 15.9% of patients. One patient developed TdP requiring emergent cardioversion. Seven patients required premature termination of therapy. The baseline QTc of patients exhibiting QTc prolongation of > 60 ms was normal.ConclusionThe combination of HY/AZ significantly prolongs the QTc in patients with COVID-19. This prolongation may be responsible for life threating arrhythmia in the form of TdP. This risk mandates careful consideration of HY/AZ therapy in lights of its unproven efficacy. Strict QTc monitoring should be performed if the regimen is given.

scholarly journals Clarithromycin-Induced Long QT Syndrome: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Mecnun Cetin ◽  
Munevver Yıldırımer ◽  
Serkan Özen ◽  
Sema Tanrıverdi ◽  
Senol Coskun
Keyword(s):  
Long Qt Syndrome ◽  
Antiarrhythmic Drugs ◽  
Macrolide Antibiotic ◽  
Torsade De Pointes ◽  
Qt Prolongation ◽  
Atypical Pneumonia ◽  
Interval Prolongation ◽  
Long Qt ◽  
Qt Interval Prolongation ◽  
Qt Syndrome

Long QT syndrome develops for a number of reasons. The number of non-antiarrhythmic drugs reported to induce QT interval prolongation with or without torsade de pointes continues to increase. Clarithromycin is a macrolide antibiotic being increasingly used for the treatment of atypical pneumonia. In this paper, we describe a patient who developed long QT prolongation syndrome after receiving clarithromycin for the treatment of atypical pneumonia.

scholarly journals Approach to initiating QT-prolonging oncology drugs in the ambulatory setting

2018 ◽  
Vol 25 (1) ◽  
pp. 198-204
Author(s):  
Mário L de Lemos ◽  
Carrie Kung ◽  
Victoria Kletas ◽  
Nadine Badry ◽  
Isabell Kang
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Qt Interval ◽  
Torsades De Pointes ◽  
Drug Approval ◽  
Qt Prolongation ◽  
Ambulatory Setting ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Oncology Practice

Since the introduction of regulatory drug approval guidance on the evaluation of QT interval prolongation, an increasing number of drug monographs has included cautions on the risk of QT prolongation. For example, QT prolongation is mentioned in the Canadian product monographs of 29 drugs commonly seen in oncology practice. This presents two major challenges. First, most guidelines and risk predictive tools for QT prolongation have been developed for hospitalized patients in acute care settings. In contrast, most QT-prolonging oncology drugs are used in medically stable patients in the ambulatory setting. Second, many oncology drugs are unique for their indications and non-QT prolonging alternative agents are often not available. In this review, we will outline an empiric initial approach to ambulatory cancer patients who are treated with oncology drugs which may prolong QT interval. This includes the predictive value of QT prolongation on torsades de pointes, the risk factors of the patients and the drugs, and the limitations of existing guidance in this area.

scholarly journals Drug-induced QT interval prolongation in cancer patients

2011 ◽  
Vol 4 (4) ◽  
pp. 223
Author(s):  
Torben K. Becker ◽  
Sai-Ching J. Yeung
Keyword(s):  
Cancer Patients ◽  
Qt Interval ◽  
Alkylating Agents ◽  
Torsade De Pointes ◽  
Interval Prolongation ◽  
Drug Induced ◽  
Vascular Disruption ◽  
Qt Interval Prolongation ◽  
Increased Risk ◽  
Multiple Drugs

Cancer patients are at an increased risk for QT interval prolongation and subsequent potentially fatal Torsade de pointes tachycardia due to the multiple drugs used for treatment of malignancies and the associated symptoms and complications. Based on a systematic review of the literature, this article analyzes the risk for prolongation of the QT interval with antineoplastic agents and commonly used concomitant drugs. This includes anthracyclines, fluorouracil, alkylating agents, and new molecularly targeted therapeutics, such as vascular disruption agents. Medications used in the supportive care can also prolong QT intervals, such as methadone, 5-HT3-antagonists and antihistamines, some antibiotics, antifungals, and antivirals. We describe the presumed mechanism of QT interval prolongation, drug-specific considerations, as well as important clinical interactions. Multiple risk factors and drug–drug interactions increase this risk for dangerous arrhythmias. We propose a systematic approach to evaluate cancer patients for the risk of QT interval prolongation and how to prevent adverse effects.

scholarly journals Managing drug-induced QT prolongation in clinical practice

2020 ◽  
pp. postgradmedj-2020-138661
Author(s):  
Rani Khatib ◽  
Fatima R N Sabir ◽  
Caroline Omari ◽  
Chris Pepper ◽  
Muzahir Hassan Tayebjee
Keyword(s):  
Qt Interval ◽  
Simple Algorithm ◽  
Torsades De Pointes ◽  
Daily Practice ◽  
Qt Prolongation ◽  
Key Factors ◽  
Drug Induced ◽  
Electrolyte Disturbances ◽  
Related Risk ◽  
Life Threatening

Many drug therapies are associated with prolongation of the QT interval. This may increase the risk of Torsades de Pointes (TdP), a potentially life-threatening cardiac arrhythmia. As the QT interval varies with a change in heart rate, various formulae can adjust for this, producing a ‘corrected QT’ (QTc) value. Normal QTc intervals are typically <450 ms for men and <460 ms for women. For every 10 ms increase, there is a ~5% increase in the risk of arrhythmic events. When prescribing drugs associated with QT prolongation, three key factors should be considered: patient-related risk factors (eg, female sex, age >65 years, uncorrected electrolyte disturbances); the potential risk and degree of QT prolongation associated with the proposed drug; and co-prescribed medicines that could increase the risk of QT prolongation. To support clinicians, who are likely to prescribe such medicines in their daily practice, we developed a simple algorithm to help guide clinical management in patients who are at risk of QT prolongation/TdP, those exposed to QT-prolonging medication or have QT prolongation.

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