Prevalencia de medicamentos que prolongan el intervalo QT en salas de cardiología de un hospital de alta complejidad / Drug induced prolongation of Q-T interval in cardiology wards

Resumen: Antecedentes: La prevalencia del síndrome del QT largo (SQTL) producido por medicamentos es una de las reacciones adversas que en el último tiempo ha aumentado en prevalencia y mortalidad. No solamente ocurre con el uso de medicamentos para el tratamiento de cardiopatías, sino también en medicamentos con otra acción terapéutica. Objetivo: Evaluar la prevalencia del síndrome del SQTL inducido por medicamentos en salas de cardiología de un hospital de alta complejidad. Métodos: Estudio prospectivo, de tipo descriptivo y de corte transversal en 36 pacientes cardiópatas, que consistió en evaluar la frecuencia del uso de medicamentos que son capaces de producir un SQTL y la prevalencia de este efecto adverso. Los datos clínicos se recolectaron de la ficha clínica y de entrevistas con los pacientes. Se efectuó un seguimiento para detectar la aparición de prolongación del intervalo QT. Los resultados obtenidos fueron presentados por medio de estadística descriptiva (programa estadístico Statgraphics Centurion, versión XVI). No hubo estadística inferencial dada la ausencia de un grupo control. Resultados: 41,7%, de los 36 pacientes presentaron SQTL que en 86,7% de ellos fue asociado a un medicamento. Los medicamentos más frecuentemente asociados a este efecto adverso fueron Amiodarona (38,5%) y Ondansetrón (23,1%), y el factor de riesgo mayormente involucrado fue el sexo femenino (61,5%). Conclusión: Existió una alta prevalencia del uso de medicamentos que producen un SQTL, destacándose que existen medicamentos utilizados para otras patologías que también pueden producirlo.

Abstract: Background: The prevalence of the Long QT interval syndrome (LQTS) associated to drugs has increased en the last decades along with an increased mortality due to this condition. It occurs not only with drugs used to treat cardiac disease but also to other drugs. Aim: To evaluate the prevalence of drug induced LQTS in cardiology wards of a high complexity hospital. Method: This is a prospective, descriptive and cross sectional study in 36 patients with heart disease. The use of drugs known to affect the QT interval along with the frequency of LGTS were evaluated. Clincal data was obtained from clinical records and personal interviews. Patients were followed for the appearance of LQTS. Descriptive were used to present the results. No inferential statistics were used as no control group was involved (Statgraphics Centurion, version XVI). Results: 41.7% of the 36 patients developed LQTS and the association with drugs was present in 86.7% of them. The drugs most commonly identified were amiodarone (38.5%) and ondansetron (23.1%) of patients. Female geneder was the most common associated condition (61.5%). Conclusion: There was a frequent use of drugs known to produce LQTS, but other drugs may also be associated int this group of patients with heart disease admitted to intensive or intermediate care facilities.

Tireotoxicose induzida pela amiodarona - revisão de literatura e atualização clínica / Amiodarone-induced thyrotoxicosis - literature review & clinical update

Resumo A amiodarona é amplamente utilizada no tratamento de arritmias atriais e ventriculares, porém devido sua alta concentração de iodo, o uso crônico da droga pode induzir distúrbios tireoidianos. A tireotoxicose induzida pela amiodarona (TIA) pode descompensar e exacerbar anormalidades cardíacas subjacentes, provocando aumento da morbidade e mortalidade, principalmente em pacientes com fração de ejeção do ventrículo esquerdo <30%. Os casos de TIA são classificados em dois subtipos que direcionam a conduta terapêutica. Os riscos e benefícios de manter a amiodarona devem ser avaliados de maneira individualizada, e a decisão de continuar ou suspender a droga deve ser tomada conjuntamente por cardiologistas e endocrinologistas. O tratamento de TIA tipo 1 é semelhante ao do hipertireoidismo espontâneo, sendo indicado o uso de drogas antitireoidianas (metimazol e propiltiouracil) em doses elevadas. A TIA tipo 1 mostra-se mais complicada, pois apresenta proporcionalmente maiores números de recorrências ou até mesmo a não remissão do quadro, sendo recomendado o tratamento definitivo (tireoidectomia total ou radioiodo). TIA tipo 2 é geralmente autolimitada, mas devido a elevada mortalidade associada a tireotoxicose em pacientes cardiopatas, o tratamento deve ser instituído para que o eutireoidismo seja atingido mais rapidamente. Em casos bem definidos de TIA tipo 2, o tratamento com corticosteroides é mais efetivo do que o tratamento com drogas antitireoidianas. Em casos graves, independentemente do subtipo, a restauração imediata do eutiroidismo por meio da tireoidectomia total deve ser considerada antes que o paciente evolua com piora clínica excessiva, pois a demora na indicação da cirurgia está associada ao aumento da mortalidade.

Abstract Amiodarone is widely used in treating atrial and ventricular arrhythmias; however, due to its high iodine concentration, the chronic use of the drug can induce thyroid disorders. Amiodarone-induced thyrotoxicosis (AIT) can decompensate and exacerbate underlying cardiac abnormalities, leading to increased morbidity and mortality, especially in patients with left ventricular ejection fraction <30%. AIT cases are classified into two subtypes that guide therapeutic management. The risks and benefits of maintaining the amiodarone must be evaluated individually, and the therapeutic decision should be taken jointly by cardiologists and endocrinologists. Type 1 AIT treatment is similar to that of spontaneous hyperthyroidism, using antithyroid drugs (methimazole and propylthiouracil) at high doses. Type 1 AIT is more complicated since it has proportionally higher recurrences or even non-remission, and definitive treatment is recommended (total thyroidectomy or radioiodine). Type 2 AIT is generally self-limited, yet due to the high mortality associated with thyrotoxicosis in cardiac patients, the treatment should be implemented for faster achievement of euthyroidism. Furthermore, in well-defined cases of type 2 AIT, the treatment with corticosteroids is more effective than treatment with antithyroid drugs. In severe cases, regardless of subtype, immediate restoration of euthyroidism through total thyroidectomy should be considered before the patient progresses to excessive clinical deterioration, as delayed surgery indication is associated with increased mortality.

Toxicidad pulmonar aguda por amiodarona con dosis baja de impregnación: reporte de caso / Acute amiodarone pulmonary toxicity with low impregnation dose: case report

Se sabe que la amiodarona, un potente antiarrítmico, causa toxicidad pulmonar. La neumonitis intersticial crónica es la presentación más común. Sin embargo, la toxicidad pulmonar aguda es rara y provoca una mayor mortalidad. Se presenta un paciente de 61 años con fibrilación auricular persistente que, tras tratamiento por un mes con amiodarona vía oral a dosis baja de impregnación de 400 miligramos al día, desarrolló toxicidad pulmonar aguda secundaria al antiarrítmico confirmada por radiografía y tomografía. Su caso tuvo resolución después de la suspensión del fármaco y tratamiento con esteroides.

Amiodarone, considered a potent antiarrhythmic, is known to cause pulmonary toxicity. Chronic interstitial pneumonitis is the most common presentation. However, acute pulmonary toxicity is rare and has a higher case fatality rate. We present a 61-year-old patient with persistent atrial fibrillation who, after a one-month treatment with oral amiodarone at a low dose impregnation of 400 mg/day, develops acute pulmonary toxicity, with radiographic and tomographic resolution after antiarrhythmic suspension and steroid treatment.

Hyponatremia in elderly patients with fragility fractures of the proximal femur: a cross-sectional study / Hiponatremia em pacientes idosos com fratura proximal de fêmur por fragilidade: um estudo transversal

ABSTRACT Introduction: Proximal femur fractures affect the mortality and morbidity of elderly individuals. Recent studies have shown an association between fragility fractures and hyponatremia, a common fluid and electrolyte balance disorder. Objectives: This study aimed to investigate the occurrence of hyponatremia in patients with fragility fractures of the proximal femur. Methods: The authors looked into the data from the medical records of patients admitted to the emergency unit of the Real Hospital Português for fragility fractures of the proximal femur from 2014 to 2017. The study included patients with serum sodium levels recorded in their charts. Results: Fourteen of 69 (20.3%) patients with proximal femur fractures had hyponatremia. The main factors linked to hyponatremia were lung disease, and prescription of amiodarone and/or antidepressants. Conclusion: In elderly individuals, fragility fractures of the proximal femur may correlate with hyponatremia, particularly among patients on amiodarone or antidepressants.

RESUMO Introdução: Fratura de fêmur proximal tem impacto na mortalidade e morbidade de idosos. Estudos recentes vêm demonstrando associação entre fratura por fragilidade e hiponatremia, um distúrbio hidroeletrolítico comum na prática médica. Objetivos: Investigar a ocorrência de hiponatremia em pacientes com fratura proximal de fêmur por fragilidade. Metodologia: Foram coletados dados a partir de prontuários de pacientes admitidos na emergência do Real Hospital Português devido à fratura proximal de fêmur por fragilidade, entre 2014 e 2017, e aqueles com natremia disponível no prontuário eletrônico foram incluídos no estudo. Resultado: Dentre os 69 pacientes com fratura de fêmur proximal, houve uma ocorrência de 14 pacientes com hiponatremia, o que corresponde a 20,3%. Os principais fatores associados à hiponatremia no estudo foram doença pulmonar, uso de amiodarona e antidepressivos. Conclusão: Em idosos, a fratura de fêmur proximal por fragilidade pode estar correlacionada com hiponatremia, principalmente quando estão sob uso de amiodarona ou antidepressivos.

Long QT syndrome secondary to drug interaction between hydroxychloroquine and amiodarone / Síndrome de QT largo secundario a la interacción entre hidroxicloroquina y amiodarona

Abstract: A 67-year-old female patient with a diagnosis of heart failure with preserved ejection fraction secondary to severe mitral regurgitation in treatment with metoprolol, spironolactone, and digoxin. She was diagnosed systemic lupus erythematosus (SLE) because of the presence of arthritis, alopecia, thrombocytopenia, direct positive Coombs +++, positive ANAs 1:1,280 and positive lupus anticoagulant. The rheumatology service indicated hydroxychloroquine 200 mg every 24 hours. She presented atrial fibrillation, and amiodarone was initiated. Two weeks later the patient was admitted because of presyncope, electrocardiogram showed sinus bradycardia with long QT interval. A temporary pacemaker was placed, and hydroxychloroquine and amiodarone suspended. Twenty-four hours later, a new electrocardiogram was taken showing pacemaker rhythm with reduction of the QT interval. After 72 hours the temporary pacemaker was removed and on the fifth day the patient was discharged with an electrocardiogram in sinus rhythm with a corrected QT (Bazett) of 456 miliseconds. The hydroxychloroquine was reinitiated following discharge. She presented another episode of atrial fibrillation, and was treated with amiodarone, hydroxychloroquine was suspended previously, and she did not present prolongation of QT interval. The long QT syndrome was present when amiodarone and hydroxychloroquine interacted.(AU)

Resumen: Paciente femenina de 67 años, con diagnóstico de insuficiencia cardiaca con fracción de expulsión preservada, secundaria a insuficiencia mitral severa, en tratamiento con metoprolol, espironolactona y digoxina. Le fue diagnosticado lupus eritematoso sistémico, debido a la presencia de artritis, alopecia, trombocitopenia, Coombs directo positivo +++, anticuerpos antinucleares positivos 1:1,280 y anticoagulante lúpico positivo. El Servicio de Reumatología indicó hidroxicloroquina 200 mg cada 24 horas. Presentó fibrilación auricular, por lo que se le inició amiodarona. Dos semanas posteriores la paciente es ingresada debido a un episodio de presíncope, se le realizó electrocardiograma que demostró bradicardia sinusal con un intervalo QT prolongado. Se le colocó un marcapasos temporal, además de que se suspendió hidroxicloroquina y amiodarona. Después de 72 horas se retiró el marcapasos, y al quinto día se egresó con un electrocardiograma en ritmo sinusal con el intervalo QT corregido por Bazett de 456 milisegundos. La hidroxicloroquina fue reiniciada al egreso. La paciente presentó otro episodio de fibrilación auricular y fue tratada con amiodarona, previa suspensión de hidroxicloroquina, sin presentar prolongación del intervalo QT. El síndrome de QT largo sólo se presentó con la interacción de amiodarona con hidroxicloroquina.(AU)

Disfunción tiroidea inducida por amiodarona en pacientes portadores de arritmias / Thyroid dysfunction induced by Amiodarone in patient with arrhythmias

Evaluar la presencia de disfunción tiroidea en pacientes con arritmias cardíacas tratados con Amiodarona (AMD) Métodos: se realizó el estudio en 24 pacientes que presentaron arritmias supraventriculares o ventriculares tratados con AMD, atendidos en el Servicio de Medicina Interna de la Ciudad Hospitalaria "Dr. Enrique Tejera" durante el período julio 2015 ­ abril 2016. Se les determinaron T3L, T4L y TSH a manera de tamizaje previo a la administración de AMD y fueron citados y divididos en 3 grupos de 3, 6 y 12 meses de tratmiento de AMD con determinación del perfil tiroideo en la consulta. Resultados: El hipotiroidismo inducido por AMD (HIA) se presentó en 20,83% (n=5), siendo más frecuente en aquellos pacientes asculinos que tenían 3 meses de tratamiento y que recibían una dosis de 1400 mg/semanal. La tirotoxicosis inducida por AMD (TIA) se presentó en 8,33% (n=2) ambos masculinos con dosis de 1400 mg/semanal. No se encontró asociación entre HIA y TIA con el tiempo, dosis, grupo etario ni género (P>0,05). T3L, T4L y TSH registraron el mayor y menor promedio a los 12 y 3 meses (P < 0,05); 12 y 6 meses; 3 y 12 meses respectivamente. Conclusión: La frecuencia de HIA fue de 20,83 % y TIA de 8,33 %. No hubo asociación estadísticamente significativa entre la HIA o TIA con la duración de consumo, dosis, grupo etario ni género. La TSH presentó el mayor promedio a los 3 meses, la T3L y T4L a los 12 meses (AU)

to evaluate the presence of thyroid dysfunction in patients with cardiac arrhythmia who were treated with Amiodarone (AMD). Methods: the study was done in 24 patients who were treated for supraventricular or ventricular arrhythmia at the Department of Internal Medicine of Hospital "Dr. Enrique Tejera" in Valencia, Venezuela from July 2015 to April 2016. FT3, FT4 and TSH were measured to the administration of AMD. The patients were divided in 3 groups according to time of use of the drug as follows: 3, 6 and 12 months, and their thyroid function was measured at each of these periods. Results: 20.83 % (n=5) presented Amiodarone induced hypothyroidism (AIH), which was more frequent in males at 3 months of treatment and who received 1400 mg weekly. Amiodarone induced thyrotoxicosis (AIT) was found in 8.33% (n=2) also in male patients using 1400mg weekly. There was no association between AIH or AIT and duration, dose of AMD, age or gender. (p>0.05) FT3, FT4 and TSH registered their higher and lower averages on 12 and 3 months (P < 0,05); 12 and 6 months; 3 and 12 months respectively. Conclusion: AIH's frequency was 20.83 % and 8.33% for AIT. There was no statistically significant association between AIH or AIT and duration, dose of AMD, age or gender TSH average measure was higher at 3 months and the FT3 and FT4 at 12 months(AU)

Acute amiodarone toxicity causing respiratory failure

Summary A 66-year-old male patient was referred to our clinic with severe pneumonia. Bronchoscopy was performed due to clinical worsening despite antibiotics and diuretic therapy, respiratory failure and radiographic progression. Because bacterial cultures of the bronchoalveolar lavage fluid were negative and after using amiodarone for almost one month, we eliminated amiodarone from his medication regimen due to suspicion of amiodarone toxicity. Accordingly, we also initiated systemic steroid therapy. Chest X-ray done after 72 hours showed a significant resolution of lung consolidations and the patient exhibited significant clinical improvement, with decline of his oxygen requirements.

Intra-Articular Pigmentation of Synovium: An Unusual Cause

An unusual grayish brown discoloration of the synovium was found during a knee arthroscopy of a 72-year-old man. He also had similar pigmentation affecting the skin on the legs, arms, hands, and face. It was found he had been taking 400 mg of amiodarone hydrochloride daily for last 7 years. Amiodarone is known to cause a slate grey pigmentation of skin and cornea, but we believe this is the first report of amiodarone-induced pigmentation of the synovium. The arthroscopist should be aware of the possibility of drug-related synovial pigmentation and include this in differential diagnosis.

Disfunción tiroidea y corazón / Thyroid dysfunction and heart

Los trastornos de la función tiroidea afectan profundamente al sistema cardiovascular. En esta revisión se presentan algunos aspectos fisiológicos de la interrelación entre tiroides y corazón, como también las consecuencias de la tirotoxicosis e hipotiroidismo sobre el aparato cardiovascular. Se analiza la influencia del hipertiroidismo en la gèc)nesis de la fibrilación auricular y del hipotiroidismo en el metabolismo de las lipoproteínas. Adicionalmente, el artículo se referirá a los potenciales efectos adversos del antiarrítmico amiodarona sobre la función tiroidea y cómo se investigan y tratan. Finalmente, se expone un caso clínico real para ilustrar con mayor claridad la enorme importancia que pueden alcanzar las relaciones fisiopatológicas entre el corazón y las afecciones de esta glándula endocrina.

Disorders of thyroid function profoundly affect the cardiovascular system. Inthisreviewsomephysiologicalaspectsoftherelationship between thyroid and the heart as well as the consequences of thyrotoxicosis and hypothyroidism on the cardiovascular system are presented. The influence of hyperthyroidism is analyzed in the genesis of atrial fibrillation and of hypothyroidism on lipoprotein metabolism. Furthermore, we refer to the potential adverse effects of the antiarrhythmic amiodarone on thyroid function and how they are investigated and treated. Finally, a real clinical case is exposed to more clearly illustrate the enormous importance that can reach the pathophysiological relationships between the heart and the diseases of the thyroid gland.

Hepatic computed tomography changes caused by amiodarone

No abstract available.

Fármacos de amplo uso na prática clínica que interagem com os hormônios tireoidianos / Widely used drugs in clinical practice that interact with thyroid hormones

Vários fármacos de amplo uso na prática clínica interagem com os hormônios tireoidianos, alterando a função da tireoide. Boa parte dos pacientes submetidos à avaliação da tireoide faz uso de diversos fármacos, sendo importante saber quais são as interações. O objetivo deste estudo foi rever, na literatura, os principais medicamentos amplamente utilizados na prática clínica que interagem com os hormônios tireoidianos. A produção desses hormônios ocorre por meio de diversos mecanismos, que podem interagir com várias drogas, resultando em disfunção tireoidiana. Alguns fármacos podem causar tanto tireotoxicose, como hipotireoidismo; é o caso do iodo, da amiodarona e da interleucina-2. A radiação ionizante pode produzir tireoidite aguda, crônica e câncer de tireoide. O carbonato de lítio inibe a secreção dos hormônios tireoidianos, estimulando o hormôniotireo estimulante e levando à formação de bócio. A quimioterapia citotóxica pode causar alterações no hipotálamo, na hipófise e na tireoide. Os glicocorticoides apresentam efeitos variáveis e múltiplos. Alguns fármacos afetam as proteínas transportadoras de hormônios tireoidianos, como os salicilatos, a heparina e o estrogênio. Anticonvulsivantes atuam sobre os hormônios tireoidianos, interferindo na ligação com proteínas transportadoras e acelerando o metabolismo hepático. A dopamina inibe diretamente a secreção do TSH. O propranolol tem efeito discreto, relacionado a doses >160mg/dia.O conhecimento sobre as interações permite identificar uma droga como causa de disfunção da tireóide, a execução de testes de triagem em indivíduos expostos a elas e evitar seu uso em pacientes com risco de desenvolver doenças da tireóide...

Many drugs of wide use in clinical practice interact with thyroid hormones, changing thyroid function. Much of the patients that have their thyroid studied make use of multiple medications, being important to know which the interactionsare. The aim of this study was to review in the literature the main drugs widely used in clinical practice that interacts with thyroid hormones. The production of these hormones occurs through several mechanisms which may interact with various drugs, causing thyroid dysfunction. Some medicines cancause both thyrotoxicosis and hypothyroidism, such as iodine, amiodarone and interleukin-2. Ionizing radiation may produce acute thyroiditis, chronic thyroiditis and thyroid cancer. Lithium carbonate inhibits the secretion of thyroid hormones, stimulating TSH, leading to the formation of goiter. Cytotoxic chemotherapy can cause changes in the hypothalamus, pituitary and thyroid. Glucocorticoids have multiple and variables effects. Some drugs affect thyroid hormones transporter proteins, such assalicylates, heparin and estrogen. Anticonvulsants have effect on thyroid hormones, interfering with protein binding carriers and accelerating hepatic metabolism. Dopamine inhibits directly the secretion of TSH. Propranolol has slight effect, related to doses>160mg/day. The knowledge about the interactions allows to identify a drug as a cause of thyroid dysfunction, the execution of screening tests in individuals exposed to them and avoid its use in patients with risk of developing thyroid disease...

Tiroiditis no-autoinmunes / Non-autoimmune thyroiditis

El término tiroiditis comprende un grupo de enfermedades de la glándula tiroides caracterizado por la presencia de inflamación, abarcando entidades autoinmunes y no-autoinmunes. Pueden manifestarse como enfermedades agudas con dolor tiroideo severo (tiroiditis subaguda y tiroiditis infecciosas), y condiciones en las cuales la inflamación no es clínicamente evidente, cursando sin dolor y presentando disfunción tiroidea y/o bocio (tiroiditis inducida por fármacos y tiroiditis de Riedel). El objetivo de esta revisión es aportar un enfoque actualizado sobre las tiroiditis no-autoinmunes cubriendo sus aspectos clínicos, diagnósticos y terapéuticos.

The term thyroiditis comprises a group of thyroid diseases characterized by the presence of inflammation, including autoimmune and non-autoimmune entities. It may manifest as an acute illness with severe thyroid pain (subacute thyroiditis and infectious thyroiditis), and conditions in which the inflammation is not clinically evident evolving without pain and presenting primarily thyroid dysfunction and/or goiter (drug-induced thyroiditis and Riedel thyroiditis). The aim of this review is to provide an updated approach on non-autoimmune thyroiditis and its clinical, diagnostic and therapeutic aspects.

Eventos cardíacos decorrentes da infusão contínua de cloridrato de amiodarona: implicações para o enfermeiro / Cardiac events originated from the continuous infusion of amiodarone hydrochloride: consequences for the nurse

O objeto de estudo são os eventos cardíacos resultantes da infusão contínua de cloridrato de amiodarona em pacientes que evoluíram com fibrilação atrial em pós-operatório de cirurgia cardíaca. Os objetivos foram descrever as características dos pacientes que receberam infusão contínua de cloridrato de amidoarona, apresentar a prevalência de bradicardia e hipotensão encontrada nos pacientes que receberam infusão contínua de cloridrato de amiodarona e discutir as implicações dos achados para a prática dos enfermeiros a partir da prevalência encontrada de bradicardia e hipotensão decorrente da infusão contínua desta substância. Trata-se de um estudo transversal, retrospectivo, documental, por meio de análise de prontuários e avaliação quantitativa dos mesmos. Desenvolvida em uma unidade de pós-operatório de cirurgia cardíaca em um hospital universitário pertencente à rede sentinela no município do Rio de Janeiro. Foi considerado hipotensão em presença de PAS menor que 90 mmHg e bradicardia em presença de frequência cardíaca menor que 60 bpm. As variáveis que caracterizavam a população do estudo e as aferições de pressão arterial e frequência cardíaca foram transcritas para um instrumento de coleta de dados dos anos de 2010 e 2011, gerando 1782 horas de infusão contínua de cloridrato de amiodarona em 27 pacientes cirúrgicos (10,50%). Tratou-se de uma população predominantemente feminina, com idade a cima de 60 anos, período de internação superior a uma semana, apresentava hipertensão arterial prévia (59,26%), era portadora de fibrilação atrial (55,56%) e o diagnóstico cirúrgico de revascularização do miocárdio com circulação extracorpórea foi predominante (70,37%). Os dados mostram que 85,19% dos pacientes eram portadores de pelo menos um fator de risco, 70,37% apresentavam dois fatores de risco e 55,55% apresentavam três fatores de risco para desenvolver fibrilação atrial no pós-operatório de cirurgia cardíaca...

The subject-matter of the following study is the cardiac events that are consequences from the continuous infusion of amiodarone hydrochloride into patients that developed atrial fibrillation in a postoperative care from a cardiac surgery. The aims of the study are: to describe the characteristics of the patients that received continuous infusion of amiodarone hydrochloride; to present the prevalence of bradycardia and hypotension in the patients that received continuous infusion of amiodarone hydrochloride; and to discuss the implications of the findings for the practice of nurses from the prevalence of bradycardia and hypotension that stemmed from the continuous infusion of amiodarone hydrochloride. This is a cross-sectional, retrospective, documentary study through the analysis and quantitative evaluation of medical records. It was developed in a cardiac surgery postoperative unit in a university hospital that belongs to the Rede Sentinela in the City of Rio de Janeiro. Hypotension was defined as the presence of a systemic arterial blood pressure (ABP) lower than 90 mmHg and bradycardia as the presence of a heart rate below 60 bpm. The variables that characterized the population of the study and the measuring of arterial blood pressure and heart rate were transcribed into a data collection instrument through the years 2010 and 2011, creating 1782 hours of continuous infusion of amiodarone hydrochloride into 27 surgical patients (10,50%). The population of the study was mainly composed of women over 60 years old, with an admission over a week period, they showed pre-existing arterial hypertension (58,26%) and have atrial fibrillation (55,56%) and the surgical diagnosis of myocardium revascularization with extracorporeal circulation was predominant (70,37%)...

The diagnostic utility of chest computed tomography scoring for the assessment of amiodarone-induced pulmonary toxicity

BACKGROUND/AIMS: Amiodarone is one of the most widely used antiarrhythmic agents; however, amiodarone-induced pulmonary toxicity (APT) can be irreversible and sometimes fatal. The aim of this study was to evaluate the feasibility of chest computed tomography (CT) as a diagnostic tool for APT and to assess the utility of the CT APT score as an index for predicting the severity of APT. METHODS: Patients underwent amiodarone treatment for various reasons, most often atrial fibrillation, for more than 2 years, and those that received a cumulative dose > 100 g were enrolled. A total of 34 patients who underwent chest CT between December 2011 and June 2012 were enrolled, whether or not they had clinical symptoms. The APT CT score was defined as the number of involved regions in the lung, which was divided into 18 regions (right and left, upper, middle, and lower, and central, middle, and peripheral). The CT findings were evaluated according to the total dose and duration of amiodarone treatment and the results of a pulmonary function test. Clinical symptoms and outcomes were also evaluated according to APT CT scores. RESULTS: Seven patients had positive APT CT scores (interstitial fibrosis in five, organizing pneumonia in one, and mixed interstitial fibrosis and organizing pneumonia in one), and these patients exhibited significantly lower diffusion capacity for carbon monoxide in the lungs compared with patients without an increased APT CT score (70.2% +/- 6.9% vs. 89.7% +/- 19.4%; p = 0.011). Three of the seven patients experienced overt APT that required hospital admission. CONCLUSIONS: Chest CT is a useful diagnostic tool for APT, and the APT CT score might be a useful index for assessing the severity of APT.

Adverse effects of long-term amiodarone therapy

No abstract available.