scholarly journals Persistent bradycardia after hypoglycaemia: a case report and a brief literature review

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Beatrice Gasperini ◽  
Pierpaolo Lamanna ◽  
Rocco Serra ◽  
Roberto Montanari ◽  
Antonio Cherubini ◽  
...  
Keyword(s):  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Clinical Case ◽  
Sinus Bradycardia ◽  
Qt Prolongation ◽  
Hypoglycaemic Episode ◽  
Supraventricular Arrhythmias ◽  
Interval Prolongation ◽  
Qt Interval Prolongation

Hypoglycaemia can cause cardiac arrhythmias such as QT interval prolongation and ventricular arrhythmias. Supraventricular arrhythmias and sinus bradycardia were rarely reported. We present the clinical case of an 84- year-old man who developed a persistent bradycardia after a hypoglycaemic episode. After restoration of normoglycaemia, bradycardia persisted for almost eighteen hours, without QT prolongation or any symptoms. Hypoglycaemia is an unusual cause of bradyarrhytmias mainly mediated by neurologic and endocrine systems. Our clinical case supports recent recommendations for more relaxed inpatient glycaemic targets in frail older adults who may be particularly vulnerable to hypoglycaemia and its consequences.

scholarly journals Prenatal Diagnosis of Atrioventricular Block and QT Interval Prolongation by Fetal Magnetocardiography in a Fetus with Trisomy 18 and SCN5A R1193Q Variant

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Lisheng Lin ◽  
Miho Takahashi-Igari ◽  
Yoshiaki Kato ◽  
Yoshihiro Nozaki ◽  
Mana Obata ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Atrioventricular Block ◽  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Sinus Bradycardia ◽  
Trisomy 18 ◽  
Interval Prolongation ◽  
Fetal Magnetocardiography ◽  
Qt Interval Prolongation ◽  
Ultrasound Findings

We report a case of fetal trisomy 18 with SCN5A R1193Q variant that presented with sinus bradycardia, 2 : 1 atrioventricular block (AVB), and QT interval prolongation. These complex arrhythmias were diagnosed by fetal magnetocardiography combined with ultrasound findings. Advanced AVB and ventricular arrhythmias were confirmed after birth. Genetic testing of the baby revealed a SCN5A R1193Q variant, which we considered could account for the various arrhythmias in this case.

scholarly journals The Dog's Role in the Preclinical Assessment of QT Interval Prolongation

2003 ◽  
Vol 31 (1_suppl) ◽  
pp. 11-16 ◽  
Author(s):  
Michael R. Gralinski
Keyword(s):  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Safety Assessment ◽  
Safety Evaluation ◽  
Regulatory Agencies ◽  
Potential Drug ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Preclinical Species ◽  
Canine Models

During the development of a new therapeutic, few pharmacodyamic outcomes currently receive as much scrutiny as the effect of a potential medication on the electrocardiographic QT interval. The recent withdrawal from marketing of several drugs due to potential drug-related cardiac arrhythmias have greatly increased concern about drug-related changes on the QT interval. In order to reduce the incidence of these idiosyncratic episodes, regulatory agencies have suggested that sponsors use more rigorous methodology during the safety evaluation of new pharmaceuticals. Along with enhanced electrocardiographic assessments during clinical trials, advanced preclinical examinations of effect on QT interval and ventricular repolarization have become de rigueur. In this arena, the beagle dog is the preclinical species often associated with the most reliable predictivity for human safety assessment. To this end, canine models of cardiovascular safety assessment are discussed along with the relevance of these assays to human electrocardiography.

scholarly journals QT Interval Prolongation in Patients Treated for COVID-19

2020 ◽  
Author(s):  
Parham Habibzadeh ◽  
Abdollah Sarami ◽  
Mahboobeh Yadollahie ◽  
Kourosh Hashemiasl ◽  
Arezoo Salahi ◽  
...  
Keyword(s):  
Serum Potassium ◽  
Cardiac Arrhythmias ◽  
Qt Interval ◽  
Serum Magnesium ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Effective Measure ◽  
Qt Interval Prolongation ◽  
Life Threatening

AbstractBackgroundMany of the drugs commonly used for the treatment of COVID-19 cause QT interval prolongation and increase the risk of life-threatening cardiac arrhythmias. It has been shown that maintaining serum potassium and magnesium levels above 4 and 3 mg/dL, respectively, would prevent the QTc prolongation.ObjectiveTo determine if keeping only the serum magnesium level above 3 mg/dL could be considered an effective measure to prevent QTc prolongation in patients with COVID-19 receiving these drugs.MethodsIn a retrograde observational study, QTc interval was measured in 14 patients diagnosed with COVID-19 before and 3 days after initiation of treatment with either hydroxychloroquine or lopinavir-ritonavir, while their serum magnesium levels were kept ≥3 mg/dL.ResultsThe baseline QTc interval of 412 (SD 36) ms significantly increased by an average of 34 (95% CI 13 to 55) ms after 3 days of treatment. 5 patients, mostly those with lower serum potassium levels, had QTc prolongation ≥60 ms.ConclusionAlthough it seems that the risk of fatal cardiac arrhythmias in this setting is not high, it is prudent to monitor the serum electrolytes, particularly potassium, in patients with COVID-19 who are treated with either hydroxychloroquine or lopinavir-ritonavir.

scholarly journals QT interval prolongation in patients with acute ischemic stroke: a report in northwest China

2019 ◽  
Vol 47 (12) ◽  
pp. 5986-5995
Author(s):  
Jine Wu ◽  
Dilimulati Nizhamuding ◽  
Peng Liu ◽  
Yongrong Jiang ◽  
Hua Qiang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Qt Interval ◽  
Sinus Bradycardia ◽  
Clinical Information ◽  
Interval Prolongation ◽  
Stroke Patients ◽  
Neurological Intensive Care Unit ◽  
Qt Interval Prolongation ◽  
Malignant Arrhythmia

Aims QT interval prolongation is common in patients with stroke and increases the risk of malignant arrhythmia and sudden death. Our aim was to analyze differences in the QT interval and electrocardiogram abnormalities between acute ischemic stroke patients and controls. Methods We retrospectively collected data from 273 patients with acute ischemic stroke from the neurological intensive care unit and 495 controls from other departments. A standard 12-lead electrocardiogram was recorded within 24 hours of hospitalization. Clinical information, the QT interval corrected for heart rate (QTc), and the incidence of electrocardiogram abnormalities were compared between groups. Results There was no difference in age, sex, or the prevalence of hypertension or diabetes mellitus between the acute ischemic stroke group and controls. Acute ischemic stroke patients showed a significantly longer QTc and a higher incidence of both sinus bradycardia and ST-T changes compared with controls. We also showed that the changes in electrocardiogram results observed in acute ischemic stroke might be transient. Conclusion Acute ischemic stroke patients may have a longer QT interval and a higher incidence of electrocardiogram abnormalities. In clinical practice, careful attention should be paid to acute ischemic stroke patients to prevent malignant arrhythmia.

scholarly journals Transient Long QT Development in a Patient with Takotsubo Cardiomyopathy

2016 ◽  
Vol 2 (2) ◽  
pp. 81-84
Author(s):  
Dániel Czuriga ◽  
Andrea Szegedi ◽  
Ferenc Győry ◽  
Attila Szilágyi ◽  
Sándor Sipka ◽  
...  
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Long Qt Syndrome ◽  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Interval Prolongation ◽  
Long Qt ◽  
Electrolyte Disturbances ◽  
Acquired Long Qt Syndrome ◽  
Qt Interval Prolongation ◽  
Qt Syndrome

Abstract QT interval prolongation on the electrocardiogram is considered a precursory sign for imminent, potentially lethal ventricular arrhythmias. Beside the inherited condition of long QT syndrome, numerous drugs, certain electrolyte disturbances and early transmural ischemia have been identified to induce reversible prolongation of the QT interval, collectively called as acquired long QT syndrome. Herein we describe a case of a patient with transient QT prolongation and Takotsubo cardiomyopathy, a rather infrequent cause of long QT development. Serial changes of the repolarization pattern were documented to demonstrate progression and resolution of the abnormal QT interval.

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 Life Threatening Severe QTc Prolongation in Patient with Systemic Lupus Erythematosus due to Hydroxychloroquine

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
John P. O’Laughlin ◽  
Parag H. Mehta ◽  
Brian C. Wong
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
Interval Prolongation ◽  
Systemic Lupus ◽  
Qt Interval Prolongation ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

We present a case of a syncopal episode resulting from significant QT interval prolongation in a patient on hydroxychloroquine for the treatment of systemic lupus erythematosus and end stage renal disease. The patient had been treated with hydroxychloroquine for two years prior to presentation. After thorough workup for secondary causes of QT interval prolongation hydroxychloroquine was discontinued and the patient’s QT interval shortened. The patient was treated with mexiletine to prevent sudden ventricular arrhythmias, which was unique compared to other documented cases in which lidocaine was used. The patient was noted to have mild prolongation of the QT interval on electrocardiogram prior to initiation of hydroxychloroquine therapy which was exacerbated by its use and may have been caused due to toxicity from underlying renal failure.

scholarly journals Tyrosine Kinase Inhibitors-Induced Arrhythmias: From Molecular Mechanisms, Pharmacokinetics to Therapeutic Strategies

2021 ◽  
Vol 8 ◽  
Author(s):  
Mengfei Cheng ◽  
Fang Yang ◽  
Jiahui Liu ◽  
Dan Yang ◽  
Shuo Zhang ◽  
...  
Keyword(s):  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Qt Interval ◽  
Clinical Evidence ◽  
Kinase Inhibitors ◽  
Qt Prolongation ◽  
Small Sample ◽  
Interval Prolongation ◽  
Preclinical Trial ◽  
Qt Interval Prolongation

With the development of anti-tumor drugs, tyrosine kinase inhibitors (TKIs) are an indispensable part of targeted therapy. They can be superior to traditional chemotherapeutic drugs in selectivity, safety, and efficacy. However, they have been found to be associated with serious adverse effects in use, such as myocardial infarction, fluid retention, hypertension, and rash. Although TKIs induced arrhythmia with a lower incidence than other cardiovascular diseases, much clinical evidence indicated that adequate attention and management should be provided to patients. This review focuses on QT interval prolongation and atrial fibrillation (AF) which are conveniently monitored in clinical practice. We collected data about TKIs, and analyzed the molecule mechanism, discussed the actual clinical evidence and drug-drug interaction, and provided countermeasures to QT interval prolongation and AF. We also pooled data to show that both QT prolongation and AF are related to their multi-target effects. Furthermore, more than 30 TKIs were approved by the FDA, but most of the novel drugs had a small sample size in the preclinical trial and risk/benefit assessments were not perfect, which led to a suspension after listing, like nilotinib. Similarly, vandetanib exhibits the most significant QT prolongation and ibrutinib exhibits the highest incidence in AF, but does not receive enough attention during treatment.

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.

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