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1.
Medicine (Baltimore) ; 100(17): e25702, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907151

RESUMO

RATIONALE: Diabetic ketoacidosis (DKA) can cause several complications. Among them, cardiac complications are the most fatal and difficult to detect. Cardiac markers are prognostic factors for morbidity and mortality in adult patients with DKA. But, there have been very few discussed cases in pediatrics. We report a case of severe DKA in child with elevated cardiac enzymes and prolonged QT interval. PATIENT CONCERNS: A 12-year-old girl admitted by nausea, vomiting, and lethargy for 1 day. DIAGNOSES: Her blood sugar level was initially undetectable by the capillary blood glucose meter, and blood gas analysis showed severe DKA with elevated cardiac enzymes and prolonged QT interval. INTERVENTIONS: The patient was admitted to hospital and intensive intravenous fluid and regular insulin infusion were administered. OUTCOMES: After 5 days of supportive care, the patient was fully recovered, discharged, and followed up in an outpatient clinic. LESSONS: Since the relationship between DKA and myocardial injury has not been clearly elucidated, pediatricians and emergency physicians should remain careful throughout the recovery time as it can lead to life-threatening conditions in various courses.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Cetoacidose Diabética , Hidratação/métodos , Insulina/administração & dosagem , Síndrome do QT Longo , Troponina I/sangue , Equilíbrio Ácido-Base , Administração Intravenosa/métodos , Gasometria/métodos , Glicemia/análise , Criança , Cetoacidose Diabética/sangue , Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/etiologia , Cetoacidose Diabética/terapia , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Cardiopatias/sangue , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Humanos , Hipoglicemiantes/administração & dosagem , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/etiologia , Peptídeo Natriurético Encefálico/sangue , Resultado do Tratamento
3.
BMC Cardiovasc Disord ; 21(1): 158, 2021 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-33784966

RESUMO

INTRODUCTION: The cause-and-effect relationship of QTc prolongation in Coronavirus disease 2019 (COVID-19) patients has not been studied well. OBJECTIVE: We attempt to better understand the relationship of QTc prolongation in COVID-19 patients in this study. METHODS: This is a retrospective, hospital-based, observational study. All patients with normal baseline QTc interval who were hospitalized with the diagnosis of COVID-19 infection at two hospitals in Ohio, USA were included in this study. RESULTS: Sixty-nine patients had QTc prolongation, and 210 patients continued to have normal QTc during hospitalization. The baseline QTc intervals were comparable in the two groups. Patients with QTc prolongation were older (mean age 67 vs. 60, P 0.003), more likely to have underlying cardiovascular disease (48% versus 26%, P 0.001), ischemic heart disease (29% versus 17%, P 0.026), congestive heart failure with preserved ejection fraction (16% versus 8%, P 0.042), chronic kidney disease (23% versus 10%, P 0.005), and end-stage renal disease (12% versus 1%, P < 0.001). Patients with QTc prolongation were more likely to have received hydroxychloroquine (75% versus 59%, P 0.018), azithromycin (18% vs. 14%, P 0.034), a combination of hydroxychloroquine and azithromycin (29% vs 7%, P < 0.001), more than 1 QT prolonging agents (59% vs. 32%, P < 0.001). Patients who were on angiotensin-converting enzyme inhibitors (ACEi) were less likely to develop QTc prolongation (11% versus 26%, P 0.014). QTc prolongation was not associated with increased ventricular arrhythmias or mortality. CONCLUSION: Older age, ESRD, underlying cardiovascular disease, potential virus mediated cardiac injury, and drugs like hydroxychloroquine/azithromycin, contribute to QTc prolongation in COVID-19 patients. The role of ACEi in preventing QTc prolongation in COVID-19 patients needs to be studied further.


Assuntos
/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Eletrocardiografia , Síndrome do QT Longo , Insuficiência Renal Crônica/epidemiologia , Fatores Etários , Idoso , /complicações , /fisiopatologia , Comorbidade , Correlação de Dados , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/epidemiologia , Síndrome do QT Longo/etiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Medição de Risco/métodos , Análise de Sobrevida , Estados Unidos/epidemiologia
4.
Int Heart J ; 62(2): 427-431, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33731522

RESUMO

In this study, we present a case of a 22-year-old female with a family history of syncope, suffering from recurrent syncope since childhood. She had an obvious prolonged QTc interval of up to 651 ms, a bifid T wave pattern on electrocardiogram, and torsade de pointes, corresponding to a syncope episode. Additionally, her echocardiogram showed left ventricular non-compaction in the apex. After treatment with mexiletine, the QTc interval has been observed to shorten immediately, and the T wave morphology recovered. A similar effect was also observed in her mother and young sister. Administration of propranolol prolonged her QTc interval. Target sequencing of candidate genes revealed a missense mutation in the pore area of the hERG protein, coded by KCNH2. We diagnosed this as a case of type 2 long QT syndrome in which mexiletine could be effective in shortening the QTc interval.


Assuntos
Eletrocardiografia/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Síndrome do QT Longo/tratamento farmacológico , Mexiletina/farmacologia , Taquicardia Ventricular/complicações , Função Ventricular Esquerda/fisiologia , Antiarrítmicos/farmacologia , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Síndrome do QT Longo/etiologia , Síndrome do QT Longo/genética , Linhagem , Taquicardia Ventricular/fisiopatologia , Adulto Jovem
6.
BMJ Case Rep ; 13(12)2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323421

RESUMO

Long QT syndrome with Torsades de Pointes (TdP) is a life-threatening polymorphic ventricular arrhythmia. The corrected QT (QTc) prolongation >500 milliseconds (ms) has been associated with TdP. Hypocalcaemia due to severe vitamin D deficiency is an uncommon cause of acquired long QT. We hereby present a case of a 40-year-old woman with sensorineural deafness and having symptoms of palpitations and presyncope. She had a QTc interval of 556 ms (reference range, QTc 451-470 ms in adult healthy woman) on 24-hour Holter analysis. Genetic analysis for congenital long QT syndrome was negative. She was diagnosed with severe hypocalcaemia secondary to severe vitamin D deficiency. After treatment with intravenous calcium gluconate, followed by oral vitamin D and calcium supplementation, the QTc became normalised and no further episode of palpitations or presyncope occurred. The causes of vitamin D deficiency was due to inadequate exposure to sunlight and a strict vegan diet.


Assuntos
Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/etiologia , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnóstico , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Adulto , Cálcio/uso terapêutico , Gluconato de Cálcio/uso terapêutico , Eletrocardiografia Ambulatorial/métodos , Feminino , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/tratamento farmacológico , Hipocalcemia/etiologia , Síndrome do QT Longo/tratamento farmacológico , Metoprolol/uso terapêutico , Vitamina D/uso terapêutico , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico
8.
Heart Rhythm ; 17(9): 1472-1479, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32438018

RESUMO

Chloroquine and hydroxychloroquine are now being widely used for treatment of COVID-19. Both medications prolong the QT interval and accordingly may put patients at increased risk for torsades de pointes and sudden death. Published guidance documents vary in their recommendations for monitoring and managing these potential adverse effects. Accordingly, we set out to conduct a systematic review of the arrhythmogenic effect of short courses of chloroquine or hydroxychloroquine. We searched on MEDLINE and Embase, as well as in the gray literature up to April 17, 2020, for the risk of QT prolongation, torsades, ventricular arrhythmia, and sudden death with short-term chloroquine and hydroxychloroquine usage. This search resulted in 390 unique records, of which 41 were ultimately selected for qualitative synthesis and which included data on 1515 COVID-19 patients. Approximately 10% of COVID-19 patients treated with these drugs developed QT prolongation. We found evidence of ventricular arrhythmia in 2 COVID-19 patients from a group of 28 treated with high-dose chloroquine. Limitations of these results are unclear follow-up and possible publication/reporting bias, but there is compelling evidence that chloroquine and hydroxychloroquine induce significant QT-interval prolongation and potentially increase the risk of arrhythmia. Daily electrocardiographic monitoring and other risk mitigation strategies should be considered in order to prevent possible harms from what is currently an unproven therapy.


Assuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Morte Súbita/etiologia , Hidroxicloroquina/uso terapêutico , Síndrome do QT Longo/etiologia , Pneumonia Viral/tratamento farmacológico , Torsades de Pointes/etiologia , Antimaláricos/uso terapêutico , Infecções por Coronavirus/complicações , Humanos , Pandemias , Pneumonia Viral/complicações
11.
J Am Assoc Nurse Pract ; 32(2): 128-135, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32015278

RESUMO

The clinical practice of pharmaceutical medicine includes contributions from physicians, pharmacists, nurse practitioners, and physician assistants. Drug safety considerations are of considerable importance. This article discusses drug-induced proarrhythmia, with a specific focus on Torsade de Pointes (Torsade), a polymorphic ventricular tachycardia that typically occurs in self-limiting bursts that can lead to dizziness, palpitations, syncope, and seizures, but on rare occasions can progress to ventricular fibrillation and sudden cardiac death. A dedicated clinical pharmacology study conducted during a drug's clinical development program has assessed its propensity to induce Torsade using prolongation of the QT interval as seen on the surface electrocardiogram (ECG) as a biomarker. Identification of QT-interval prolongation does not necessarily prevent a drug from receiving marketing approval if its overall benefit-risk balance is favorable, but, if approved, a warning is placed in its Prescribing Information. This article explains why drugs can have a proarrhythmic propensity and concludes with a case presentation.


Assuntos
Arritmias Cardíacas/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Arritmias Cardíacas/fisiopatologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Eletrocardiografia/métodos , Humanos , Síndrome do QT Longo/etiologia , Síndrome do QT Longo/fisiopatologia , Torsades de Pointes/etiologia , Torsades de Pointes/fisiopatologia
12.
Dev Med Child Neurol ; 62(7): 833-836, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31797351

RESUMO

AIM: To identify factors associated with baseline prolonged corrected QT (QTc) and higher risk of QTc prolongation during follow-up in patients with Rett syndrome (RTT). METHOD: A retrospective review of patients receiving an electrocardiogram (ECG) between June 2012 and June 2018 was performed. Age, methyl-CpG binding protein 2 gene (MECP2) mutation, RTT Severity Scale (RSSS) score, breathing abnormalities, seizure frequency, medications, and ECG parameters were collected. Prolonged QTc was defined as greater than or equal to 460ms. Comparisons at baseline and during follow-up were made. RESULTS: In total, 129 unique patients (all female) had 349 ECGs. At baseline, 12 (9.3%) had a prolonged QTc (median 474ms, interquartile range 470-486ms) and were more likely to have moderate/severe breathing abnormalities (66.7% vs 24.8%; p=0.005) and take selective serotonin reuptake inhibitors (SSRIs) (41.7% vs 15.4%; p=0.04). There was no difference in age, RSSS score, seizures, or mutation. Twenty-six developed prolonged QTc during a median follow-up of 1 year 7 months (interquartile range 0-3y 6mo). QTc prolongation was associated with p.(Thr158Met) mutation versus the remaining six common mutations (hazard ratio 4.1, 95% confidence interval 1.4-12.0; p=0.01) but not with age, RSSS score, seizures, breathing abnormalities, or SSRIs. INTERPRETATION: Breathing abnormalities and SSRIs were associated with baseline QTc prolongation and those with p.(Thr158Met) mutation were more likely to develop prolonged QTc over time. Identification of patients with prolonged QTc warrants increased clinical monitoring. WHAT THIS PAPER ADDS: Breathing abnormalities and selective serotonin reuptake inhibitors are associated with prolonged baseline corrected QT (QTc). Development of QTc prolongation is associated with the p.(Thr158Met) mutation.


Assuntos
Síndrome do QT Longo , Proteína 2 de Ligação a Metil-CpG/genética , Transtornos Respiratórios , Síndrome de Rett , Inibidores de Captação de Serotonina/efeitos adversos , Criança , Eletrocardiografia , Feminino , Seguimentos , Humanos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/etiologia , Síndrome do QT Longo/fisiopatologia , Transtornos Respiratórios/complicações , Transtornos Respiratórios/fisiopatologia , Estudos Retrospectivos , Síndrome de Rett/complicações , Síndrome de Rett/tratamento farmacológico , Síndrome de Rett/genética
13.
Ren Fail ; 42(1): 54-65, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31878817

RESUMO

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in chronic kidney disease (CKD) patients. QT interval prolongation is a congenital or acquired condition that is associated with an increased risk of torsade de pointes (TdP), sudden cardiac death (SCD), and all-cause mortality in the general population. The prevalence of acquired long QT syndrome (aLQTS) is high, and various acquired conditions contribute to the prolonged QT interval in patients with CKD. More notably, the prolonged QT interval in CKD is an independent risk factor for SCD and all-cause mortality. In this review, we focus on the epidemiological characteristics, risk factors, underlying mechanisms and treatments of aLQTS in CKD, promoting the management of aLQTS in CKD patients.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Síndrome do QT Longo/epidemiologia , Insuficiência Renal Crônica/complicações , Antiarrítmicos/uso terapêutico , Estimulação Cardíaca Artificial/métodos , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Frequência Cardíaca/efeitos dos fármacos , Humanos , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/etiologia , Síndrome do QT Longo/terapia , Prevalência , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Literatura de Revisão como Assunto , Fatores de Risco
15.
Pediatr Cardiol ; 41(2): 414-417, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31599347

RESUMO

We report a case of QTc prolongation associated with mild concussion in a pediatric patient. An 11-year-old male presented to the emergency department after sustaining a head injury during football practice. He complained of headache and blurry vision. Physical examination was within normal apart from an irregular heart rhythm. Electrocardiogram (ECG) showed normal sinus rhythm with QTc (Bazett formula) 460 ms. The patient was diagnosed with concussion and referred for cardiology follow-up of the QTc. ECG the next day showed QTc 462 ms (heart rate 105 bpm) supine and 494 ms after suddenly standing up (heart rate 120 bpm). Family history was negative for sudden cardiac events. Exercise stress testing 1 week later showed a baseline QTc 462 ms and 488 ms at 4 min into recovery. Holter monitoring showed evidence of increased parasympathetic activity manifested by marked sinus arrhythmia. Repeated ECG, exercise stress testing, and Holter monitoring 3 months later showed normalized QTc values. His concussion symptoms were resolved at the time of repeat testing. Mild head trauma/concussion could be associated with prolonged QTc and abnormal cardiac repolarization. While these changes seem to be self-limiting, they remain a possible substrate for malignant arrhythmias. Recognition of these changes would lead to appropriate reassurance and/or precautions in the acute setting, especially in at-risk populations such as long QT syndrome patients.


Assuntos
Concussão Encefálica/complicações , Síndrome do QT Longo/etiologia , Criança , Eletrocardiografia , Eletrocardiografia Ambulatorial , Humanos , Síndrome do QT Longo/diagnóstico , Masculino , Fatores de Risco
16.
Trends Cardiovasc Med ; 30(5): 310-312, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31477495

RESUMO

Arrhythmogenic ingredients in our diet such as mushrooms, licorice, toxic honey, liquid protein drinks, etc. have long been recognized as rare but important considerations in the differential diagnosis of arrhythmias. Anecdotal reports of torsades de pointes (TdP), arrhythmias and/or sudden death and small studies in normal subjects have suggested that simple ingredients such as grapefruit juice or ingredients in energy drinks marketed as dietary supplements could have direct arrhythmogenic actions, especially in patients with congenital long QT syndrome (cLQTS). Two recent studies that employed the industry-standard "thorough QT" trial design leave no doubt that grapefruit juice and some energy drinks can prolong the QTc interval and to exceed 500 msec. in some patients with cLQTS, a threshold known to signal imminent danger. These reports raise numerous clinically important questions such as which other patients may be at risk of arrhythmias. For example, patients with multiple clinical risk factors for TdP (hypokalemia, bradycardia, female sex, etc.) may be at risk from these and possibly other dietary ingredients ingested by millions of people each day. It is essential that further research evaluate the safety of these and similar food products and that vulnerable patients, especially those with cLQTS, be warned of this serious and emerging threat.


Assuntos
Citrus paradisi/efeitos adversos , Bebidas Energéticas/efeitos adversos , Frutas/efeitos adversos , Sistema de Condução Cardíaco/fisiopatologia , Síndrome do QT Longo/etiologia , Plantas Tóxicas/efeitos adversos , Torsades de Pointes/etiologia , Toxinas Biológicas/efeitos adversos , Potenciais de Ação , Animais , Inocuidade dos Alimentos , Frequência Cardíaca , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Período Refratário Eletrofisiológico , Medição de Risco , Fatores de Risco , Torsades de Pointes/diagnóstico , Torsades de Pointes/fisiopatologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-31795277

RESUMO

: Background: Work-related stress is a potential cardiovascular risk factor, but the underlying mechanism is not fully explained. The autonomic nervous system control of cardiac function might play a specific role; therefore, monitoring the QT interval in the electrocardiogram can highlight an autonomic imbalance induced by occupational stressors. The aim of our study was to explore the QT interval parameters as early indicators of imbalance of the autonomic cardiac function in relation to work-related stress. METHODS: During 2015-2016 annual workplace health surveillance, we measured work-related stress in 484 workers of a logistic support company using the Health and Safety Executive (HSE) tool. We assessed the frequency-corrected QT (QTc) interval and the QT index (QTi) on the electrocardiogram of each participant, and collected demographic and clinical data. We compared the QTc values by the four Karasek's categories (active/passive jobs, low/high strain job), and by job support (present/lacking), and conducted multivariate analysis to adjust for possible confounders. RESULTS: The results of the multivariate regression analysis showed that QTc was prolonged among workers operating at a specific site where stress level was found to be elevated. Regular physical activity showed a beneficial effect against QTc prolongation. We did not observe an effect on QTc length by the cross-combined Karasek's categories of job control, job demand, and job support. CONCLUSIONS: Our study suggests subclinical effects of conditions associated with work-related stress on the autonomic regulation of cardiac function. Further research is warranted to elucidate the combined effect of work organization and lifestyle factors on autonomic cardiac function.


Assuntos
Síndrome do QT Longo/etiologia , Estresse Ocupacional/fisiopatologia , Estresse Ocupacional/psicologia , Local de Trabalho , Adulto , Eletrocardiografia , Feminino , Coração/fisiopatologia , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Ocupações , Inquéritos e Questionários
18.
Antivir Ther ; 24(6): 459-465, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31570667

RESUMO

BACKGROUND: The purpose of this review is to critically analyse data regarding the prevalence and risk factors for developing a prolonged QTc interval and subsequent sudden cardiac death (SCD) in persons living with HIV (PLWH). METHODS: A systematic literature search using PubMed and Google Scholar databases was performed using the following search terms: 'HIV and prolonged QTc' and 'managing HIV-patients with prolonged QTc'. References within articles of interest were also evaluated. RESULTS/DISCUSSION: PLWH are at an increased risk of having a prolonged QTc interval. Some risk factors for this include the virus itself, concomitant medications, comorbid conditions, addictions and electrolyte disturbances. PLWH who have an increased HIV RNA viral load or decreased CD4+ T-cell count are at further risk for progressing to sudden cardiac death (SCD). Many medications commonly prescribed in the PLWH population, such as antiretrovirals and antimicrobials used in opportunistic infection prophylaxis, have also been shown to promote QTc prolongation through inhibition of human ether-a-go-go potassium channels or through drug metabolism inhibition of other QTc prolonging drugs. CONCLUSIONS: Due to the high number of risk factors associated with QTc prolongation, clinicians should incorporate baseline and routine ECG monitoring for PLWH to potentially lower the increased risk of SCD in PLWH.


Assuntos
Infecções por HIV/complicações , Síndrome do QT Longo/epidemiologia , Síndrome do QT Longo/etiologia , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/uso terapêutico , Antirretrovirais/efeitos adversos , Antirretrovirais/uso terapêutico , Contagem de Linfócito CD4 , Morte Súbita Cardíaca , Gerenciamento Clínico , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/terapia , Masculino , Prevalência , Medição de Risco , Fatores de Risco , Carga Viral
19.
J Emerg Med ; 57(4): e99-e104, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31630892

RESUMO

BACKGROUND: Ibogaine is a psychoactive indole alkaloid that has been investigated for use as a treatment for opioid addiction. While not commercially available in the United States, it is available via Internet suppliers. Ibogaine use has been associated with significant cardiac and neurologic effects, such as QT-segment prolongation, cardiac dysrhythmias, hallucinations, seizures, and central nervous system depression. We present a case of verified ibogaine exposure with associated QTc prolongation and torsade de pointes with qualitative analysis of the ingested substance, and examine the history, social context, availability, and perceptions of ibogaine's effects and safety. CASE REPORT: A 34-year-old white woman with medical history significant for heroin and cocaine use disorder presented with reported seizures 1 day after ingestion of 2 g ibogaine powder purchased from an Internet supplier. Shortly after ingestion, she experienced hallucinations and was reported by family to have four to five seizure-like episodes, at one point becoming apneic. In the emergency department, she was noted to have QTc prolongation and several episodes of torsade de pointes. Qualitative analysis confirmed the presence of ibogaine in the empty foil packages containing the ingested substance. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As increasing numbers of opioid-dependent patients attempt to curtail their substance use disorders, we anticipate a rise in ibogaine exposures, necessitating awareness by front-line clinicians in recognizing and treating a drug exposure that can rapidly become life-threatening.


Assuntos
Arritmias Cardíacas/etiologia , Ibogaína/efeitos adversos , Convulsões/etiologia , Adulto , Antagonistas de Aminoácidos Excitatórios/efeitos adversos , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Feminino , Dependência de Heroína/complicações , Dependência de Heroína/psicologia , Humanos , Ibogaína/uso terapêutico , Síndrome do QT Longo/etiologia , Tabernaemontana/efeitos adversos
20.
Arch Cardiovasc Dis ; 112(11): 699-712, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31477476

RESUMO

BACKGROUND: Long QT syndrome (LQTS) can cause the potentially fatal ventricular tachycardia torsades de pointes (TdP). QT interval corrected for heart rate (QTc) is shorter in men than in women, with testosterone contributing to shorten QTc. We recently described male hypogonadism as a reversible risk factor for acquired LQTS and TdP, but the clinical characteristics of such patients have not been characterized. AIMS: To describe the clinical characteristics of men with acquired LQTS or TdP associated with hypogonadism caused by endocrine conditions or androgen deprivation therapy (ADT), and to evaluate the relationship between testosterone concentrations and electrocardiographic changes. METHODS: We searched MEDLINE (to 04 January 2019) and the French pharmacovigilance database (to 09 August 2018) to identify male cases of acquired LQTS and TdP associated with endocrine hypogonadism or ADT; their narratives were gathered from reporting collaborators. RESULTS: We identified seven cases of TdP (one fatal) with endocrine hypogonadism, abnormally long QTc and morphologically abnormal T-wave notches. After reversion of low testosterone concentrations in the surviving patients (N=6), QTc shortened, T-wave morphology normalized and there was no TdP recurrence. Among these cases, none had mutation in the LQTS genes, three men required testosterone and three had reversible hypogonadism after resolution of a concurrent acute severe illness. We found an additional 27 reports of men with LQTS (N=6), TdP (N=9; 2/9 fatal) or sudden death (N=12; 10/12 fatal) suspected to be induced or favoured by ADT (24/27 for prostate cancer). Generally, after ADT withdrawal, QTc shortened and no TdP recurred. CONCLUSION: We propose seeking for hypogonadism caused by endocrine conditions or ADT in men presenting with TdP. Caution is warranted when ADT is used in situations at risk of TdP. Testosterone may be useful to treat or prevent TdP.


Assuntos
Antagonistas de Androgênios/efeitos adversos , Frequência Cardíaca , Hipogonadismo/induzido quimicamente , Síndrome do QT Longo/etiologia , Testosterona/deficiência , Torsades de Pointes/etiologia , Idoso , Biomarcadores/sangue , Morte Súbita Cardíaca/etiologia , Humanos , Hipogonadismo/sangue , Hipogonadismo/diagnóstico , Hipogonadismo/mortalidade , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/mortalidade , Síndrome do QT Longo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Farmacovigilância , Prognóstico , Fatores de Risco , Testosterona/sangue , Torsades de Pointes/diagnóstico , Torsades de Pointes/mortalidade , Torsades de Pointes/fisiopatologia , Adulto Jovem
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