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1.
J Stroke Cerebrovasc Dis ; 28(11): 104308, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31416760

RESUMO

Stroke involving some areas of the cerebral hemisphere, such as insula, amygdala, and lateral hypothalamus, may cause changes in autonomic control of cardiac function. A 58-year-old woman presented to the emergency department for acute onset of left facial-brachial-crural hemiparesis and dysarthria. A brain CT scan showed subacute ischemic lesion with hemorrhagic infarction in right insular-rolandic cortex. Over the next few days ECG showed severe bradycardia with elongation of QTc, significative pauses (5 seconds), runs of nonsustained ventricular tachycardia and torsades de pointes. Drug induced and other several possible causes of elongation of QT and bradycardia such as hypokalemia, a history of heart failure, and structural heart disease were ruled out. The case confirms that insular cortex plays a major role in stroke-induced cardiovascular changes.


Assuntos
Córtex Cerebral/irrigação sanguínea , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Síndrome do QT Longo/etiologia , Acidente Vascular Cerebral/complicações , Torsades de Pointes/etiologia , Potenciais de Ação , Bradicardia/etiologia , Bradicardia/fisiopatologia , Estimulação Cardíaca Artificial , Córtex Cerebral/diagnóstico por imagem , Feminino , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Síndrome do QT Longo/terapia , Pessoa de Meia-Idade , Marca-Passo Artificial , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Torsades de Pointes/diagnóstico , Torsades de Pointes/fisiopatologia , Torsades de Pointes/terapia , Resultado do Tratamento
2.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451477

RESUMO

Thyroid storm (accelerated hyperthyroidism) is an uncommon life-threatening emergency. The diagnosis is difficult and at times delayed owing to atypical presentation. Early diagnosis is the key to its successful management. We came across a patient who had presentations of acute abdomen but later diagnosed in thyroid storm. Multiorgan involvement leads all resuscitative measures futile and prevented us to salvage the patient.


Assuntos
Dor Abdominal , Hipoglicemia , Enteropatias/diagnóstico , Icterícia , Insuficiência de Múltiplos Órgãos , Crise Tireóidea , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Deterioração Clínica , Tratamento Conservador/métodos , Cuidados Críticos/métodos , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/etiologia , Icterícia/diagnóstico , Icterícia/etiologia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Crise Tireóidea/sangue , Crise Tireóidea/complicações , Crise Tireóidea/diagnóstico , Crise Tireóidea/terapia , Torsades de Pointes/diagnóstico , Torsades de Pointes/etiologia
5.
J Clin Psychopharmacol ; 39(2): 100-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30707117

RESUMO

PURPOSE/BACKGROUND: Prolonged ventricular repolarization, measured by heart rate-corrected QT interval (QTc) prolongation, might be a biomarker for risk of torsade de pointes (TdP) and sudden cardiac death. However, the predictive value of QTc has been challenged, and a component of QTc, peak-to-end of the T-wave (Tpe), and a high Tpe/QT ratio might be superior biomarkers because they better reflect increased transmural dispersion of ventricular myocyte repolarization, which can lead to TDP. The purpose of this pilot study was to provide the first measurements of heart rate, QTc, Tpe, Tpe/QTc, and their variability over 24 hours in medication-free patients with schizophrenia, during treatment with ziprasidone or other antipsychotic drugs, and healthy controls. METHODS: Subjects included 12 patients treated with ziprasidone, 30 treated with other antipsychotic drugs, 3 unmedicated patients, and 15 normal controls. Subjects underwent 24-hour analog Holter recording, and the recordings were digitized. A cardiologist blind to treatment selected multiple 10-cycle segments throughout each recording and measured the electrocardiogram metrics. RESULTS: Variability in QTc, Tpe, and Tpe/QTc over the 24 hours was present in all groups; 91.1% of patients and 100% of controls had 1 or more QTc values of 450 milliseconds or greater. Mean QTc length was significantly greater in the ziprasidone-treated than the non-ziprasidone-treated patients (P = 0.02). Mean Tpe was not elevated in the ziprasidone patients, whereas mean Tpe/QTc was lower (P < 0.01). CONCLUSIONS: The large variability in QTc, Tpe, and Tpe/QTc observed supports the need for 24-hour electrocardiogram recordings to provide an accurate assessment of risk of TdP. Heart rate-corrected QT interval alone does not capture the risk of TdP.


Assuntos
Antipsicóticos/efeitos adversos , Frequência Cardíaca/efeitos dos fármacos , Piperazinas/efeitos adversos , Tiazóis/efeitos adversos , Torsades de Pointes/induzido quimicamente , Adulto , Antipsicóticos/administração & dosagem , Estudos de Casos e Controles , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Piperazinas/administração & dosagem , Tiazóis/administração & dosagem , Torsades de Pointes/diagnóstico
6.
Clin Toxicol (Phila) ; 57(4): 234-239, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30260244

RESUMO

INTRODUCTION: New QT correction formulae derived from large populations are available such as Rautaharju's [QTcRTH = QT * (120 + HR)/180] and Dmitrienko's [QTcDMT = QT/RR0.413]. These formulae were derived from 57,595 and 13,039 cases, respectively. Recently, a study has shown that they did not experience errors across a wide range of heart rates compared to others. OBJECTIVES: (1) To determine the best cut-off value of QTcRTH and QTcDMT as a predictor of torsade de pointes (TdP) and (2) to compare the sensitivity and specificity using the cut-off value of QTcRTH with those of the QTcBazett (QTcBZT), QTcFridericia (QTcFRD), and QT nomogram. METHODS: Data were derived from two data sets. All cases aged over 18 years with an exposure to QT-prolonging drugs. Group-1, all cases developed TdP. Data in Group-1 were obtained from systematic review of reported cases from Medline since its establishment until 10 December 2015. Group-2 is composed of those who overdosed on QT prolonging drugs but did not develop TdP. This data set was previously extracted from a chart review of three medical centers from January 2008 to December 2010. Data from both groups were used to calculate QTcRTH and QTcDMT. The cut-off values from QTcRTH and QTcDMT that provided the best sensitivity and specificity to predict TdP were then selected. The same method was applied to find those values from QTcBZT, QTcFRD, and QT nomogram. The receiver operating characteristic curve (ROC) was applied where appropriate. RESULTS: Group-1, 230 cases of drug-induced TdP were included from the systematic review of Medline. Group-2 (control group), which did not develop TdP, consisted of 292 cases. After applying all of the correction methods to the two datasets, the best cut-off values that provided the best accuracy (Ac) with the best sensitivity (Sn) and specificity (Sp) for each formula were as follows: QTcRTH at 477 milliseconds (ms), Ac = 89.08%, Sn = 91.30% (95%CI = 86.89-94.61), Sp = 87.33%(95%CI = 82.96-90.92); QTcDMT at 475 ms, Ac = 88.31%, Sn =91.30% (95%CI = 86.89-94.61), Sp = 85.96%(95%CI = 81.44-89.73); QTcBZT at 490 ms, Ac = 86.97%, Sn = 88.26% (95%CI = 83.38-92.12), Sp = 85.96% (95%CI = 81.44-89.73); QTcFRD at 473 ms, Ac = 88.89%, Sn = 89.13% (95%CI = 84.37-92.84), Sp =88.70% (95%CI = 84.50-92.09). We found a significant difference (p-value = 0.0020) between area under the ROC of the QTcRTH (0.9433) and QTcBZT (0.9225) but not QTcFRD (0.9338). The Ac, Sn, and Sp of the QT nomogram were 89.08%, 91.30% (95%CI = 86.89-94.61), and 87.33% (95%CI = 82.96-90.92), respectively, and they were all equal to those of QTcRTH. CONCLUSION: Rautaharju method not only produced minimal errors for QT interval correction but also at QTcRTH 477 ms, it could predict TdP as accurately as QT nomogram and was better than the QTcBZT.


Assuntos
Eletrocardiografia/métodos , Torsades de Pointes/induzido quimicamente , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Overdose de Drogas/complicações , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Síndrome do QT Longo/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Nomogramas , Curva ROC , Sensibilidade e Especificidade , Torsades de Pointes/diagnóstico , Adulto Jovem
8.
Am J Case Rep ; 19: 1515-1518, 2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-30568157

RESUMO

BACKGROUND QT prolongation is a common, easily overlooked clinical problem with potentially dire consequences. Drug-induced and congenital forms are not mutually exclusive, but are treated differently. Here, we present a case of cryptogenic underlying congenital long QT syndrome (cLQTS) successfully treated with isoproterenol, a drug contraindicated in most congenital forms of this condition. CASE REPORT We present the case of a 54-year-old man who experienced severe QT prolongation after drug administration followed by recurrent episodes of torsade de pointes (TdP) with subsequent ventricular fibrillation (VF) arrest unresponsive to typical therapy. After failing electrolyte repletion, magnesium, amiodarone, and lidocaine, the patient was started on an isoproterenol drip to achieve a heart rate of at least 90 beats per minute (bpm). Isoproterenol resulted in an immediate near-normalization of his QT interval and cessation of his recurrent TdP. The patient was subsequently found to have a mutation of undetermined significance in the KCNQ1 gene, which is implicated in long QT syndrome type 1 (LQT1). Although isoproterenol is contraindicated in LQT1, our patient had an astonishingly therapeutic benefit. CONCLUSIONS After reviewing the electrophysiology of the delayed rectifier potassium current as it relates to long QT syndrome, we propose a mechanism by which our patient's specific mutation may have allowed him to derive benefit from isoproterenol treatment. We believe that there are patients with variants of LQT1 who can be safely treated with isoproterenol.


Assuntos
Eletrocardiografia , Síndrome do QT Longo/diagnóstico , Torsades de Pointes/diagnóstico , Cardiotônicos/uso terapêutico , Humanos , Isoproterenol/uso terapêutico , Canal de Potássio KCNQ1/genética , Síndrome do QT Longo/genética , Masculino , Pessoa de Meia-Idade , Mutação , Síndrome de Romano-Ward/tratamento farmacológico , Síndrome de Romano-Ward/etiologia , Torsades de Pointes/complicações
10.
Heart ; 104(22): 1859-1863, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29720397

RESUMO

OBJECTIVE: A prolonged QTc (LQT) is a surrogate for the risk of torsade de pointes (TdP). QTc interval duration is influenced by sex hormones: oestradiol prolongs and testosterone shortens QTc. Drugs used in the treatment of breast cancer have divergent effects on hormonal status. METHODS: We performed a disproportionality analysis using the European database of suspected adverse drug reaction (ADR) reports to evaluate the reporting OR (ROR χ2) of LQT, TdP and ventricular arrhythmias associated with selective oestrogen receptor modulators (SERMs: tamoxifen and toremifene) as opposed to aromatase inhibitors (AIs: anastrozole, exemestane and letrozole). When the proportion of an ADR is greater in patients exposed to a drug (SERMs) compared with patients exposed to control drug (AIs), this suggests an association between the specific drug and the reaction and is a potential signal for safety. Clinical and demographic characterisation of patients with SERMs-induced LQT and ventricular arrhythmias was performed. RESULTS: SERMs were associated with higher proportion of LQT reports versus AIs (26/8318 vs 11/14851, ROR: 4.2 (2.11-8.55), p<0.001). SERMs were also associated with higher proportion of TdP and ventricular arrhythmia reports versus AIs (6/8318 vs 2/14851, ROR: 5.4 (1.29-26.15), p:0.02; 16/8318 vs 12/14851, ROR: 2.38 (1.15-4.94), p:0.02, respectively). Mortality was 38% in patients presenting ventricular arrhythmias associated with SERMs. CONCLUSIONS: SERMs are associated with more reports of drug-induced LQT, TdP and ventricular arrhythmias compared with AIs. This finding is consistent with oestradiol-like properties of SERMs on the heart as opposed to effects of oestrogen deprivation and testosterone increase induced by AIs. TRIAL REGISTRATION NUMBER: NCT03259711.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Inibidores da Aromatase/efeitos adversos , Sistema de Condução Cardíaco/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Síndrome do QT Longo/induzido quimicamente , Moduladores Seletivos de Receptor Estrogênico/efeitos adversos , Tamoxifeno/efeitos adversos , Torsades de Pointes/induzido quimicamente , Potenciais de Ação/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiotoxicidade , Bases de Dados Factuais , Europa (Continente)/epidemiologia , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/mortalidade , Síndrome do QT Longo/fisiopatologia , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Torsades de Pointes/diagnóstico , Torsades de Pointes/mortalidade , Torsades de Pointes/fisiopatologia , Adulto Jovem
12.
J Cardiovasc Electrophysiol ; 29(3): 489-496, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29292852

RESUMO

Today, understanding the true risk of adverse events in long-QT syndrome (LQTS) populations may be extremely complex and potentially dependent on many factors such as the affected gene, mutation location, degree of QTc prolongation, age, sex, and other yet unknown factors. In this context, risk stratification by genotype in LQTS patients has been extremely difficult, also during exercise practice, especially due to the lack of studies that would lead to a better understanding of the natural history of each mutation and its impact upon athletes. The creation of individualized guidelines for sport participation is a goal yet to be achieved not only due to the complexity of genotype effect on the phenotype in this patient population, but also due to penetrance in genotype-positive patients. This article summarizes current knowledge and raises questions concerning the difficult relationship between exercise practice and LQTS.


Assuntos
Exercício , Frequência Cardíaca , Síndrome do QT Longo , Torsades de Pointes , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Teste de Esforço , Predisposição Genética para Doença , Frequência Cardíaca/genética , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/genética , Síndrome do QT Longo/fisiopatologia , Síndrome do QT Longo/terapia , Técnicas de Diagnóstico Molecular , Fenótipo , Prognóstico , Medição de Risco , Fatores de Risco , Torsades de Pointes/diagnóstico , Torsades de Pointes/genética , Torsades de Pointes/fisiopatologia , Torsades de Pointes/terapia
14.
Australas Psychiatry ; 26(1): 50-55, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28836822

RESUMO

OBJECTIVES: There is an increased rate of sudden cardiac death (SCD) in mental health patients. Some antipsychotic medications are known to prolong the QT interval, thus increasing a patient's risk of SCD via the arrhythmia, torsades de pointes (TdP). Our aim was to evaluate assessment for QT prolongation within a public inpatient mental health facility by auditing electrocardiograph (ECG) use. METHODS: We reviewed records of all mental health inpatient admissions to a public emergency mental health inpatient unit between 1 January 2016 and 11 February 2016. ECG availability was noted and QT interval was manually measured and assessed for risk of TdP using the QT nomogram when present. Demographic information and medication use was collected. RESULTS: Of 263 mental health inpatient admissions, 50 (19%) presentations had an ECG. A total of four (8%) had a prolonged QT interval. Of the 50 patients with an ECG, 12 (24%) were taking medication known to prolong the QT interval. CONCLUSIONS: There was very limited risk assessment for QT prolongation in a public hospital psychiatric inpatient unit, with less than 20% of patients having an ECG performed. Our study supports an association between QT-prolonging drugs and a clinically significant prolonged QT interval; however, a larger study with routine ECG screening is required.


Assuntos
Antipsicóticos/efeitos adversos , Eletrocardiografia/métodos , Hospitais Psiquiátricos , Pacientes Internados , Síndrome do QT Longo/diagnóstico , Transtornos Mentais/terapia , Torsades de Pointes/diagnóstico , Eletrocardiografia/efeitos dos fármacos , Humanos , Síndrome do QT Longo/induzido quimicamente , Torsades de Pointes/induzido quimicamente
15.
Trends Cardiovasc Med ; 28(2): 94-99, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28801207

RESUMO

Since the 1990s, when numerous non-cardiac drugs were first recognized to have the potential to prolong the QT interval and cause torsades de pointes (TdP), clinicians, drug regulators, drug developers, and clinical investigators have become aware of the complexities of assessing evidence and determining TdP causality for the many drugs being marketed or under development. To facilitate better understanding, the Arizona Center for Education and Research on Therapeutics, known as AZCERT, has developed the CredibleMeds.org website which includes QTdrugs, a listing of over 220 drugs placed in four risk categories based on their association with QT prolongation and TdP. Since the site was launched in 1999, it has become the single and most reliable source of information of its kind for patients, healthcare providers, and research scientists. Over 96,000 registered users rely on the QTdrugs database as their primary resource to inform their medication use, their prescribing or their clinical research into the impact of QT-prolonging drugs and drug-induced arrhythmias. The QTdrugs lists are increasingly used as the basis for clinical decision support systems in healthcare and for metrics of prescribing quality by healthcare insurers. A free smartphone app and an application program interface enable rapid and mobile access to the lists. Also, the CredibleMeds website offers numerous educational resources for patients, educators and healthcare providers that foster the safe use of medications.


Assuntos
Serviços de Informação sobre Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Sistema de Condução Cardíaco/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Síndrome do QT Longo/induzido quimicamente , Torsades de Pointes/induzido quimicamente , Potenciais de Ação/efeitos dos fármacos , Tomada de Decisão Clínica , Bases de Dados Factuais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Segurança do Paciente , Medição de Risco , Fatores de Risco , Torsades de Pointes/diagnóstico , Torsades de Pointes/fisiopatologia
16.
Pacing Clin Electrophysiol ; 41(4): 422-424, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28617967

RESUMO

We present a case of sudden cardiac arrest 7 hours after radiofrequency ablation of the atrioventricular junction for symptomatic permanent atrial fibrillation unresponsive to medical therapy. The Holter monitoring revealed a progressive increasing of QT interval after the procedure, highlighting the repolarization instability after acute changes in heart rates associated with modification of ventricular activation, leading to occurrence of short coupling interval ventricular extra beats and finally to a "torsade de pointes." This illustration underlines the need to program a relatively rapid ventricular rate first weeks after junction ablation, especially in case of rapid ventricular rate prior to the procedure, as well as the role of continuous ECG and QT interval monitoring during hospital stay.


Assuntos
Fibrilação Atrial/cirurgia , Morte Súbita Cardíaca , Eletrocardiografia Ambulatorial , Complicações Pós-Operatórias/diagnóstico , Ablação por Radiofrequência , Torsades de Pointes/diagnóstico , Idoso de 80 Anos ou mais , Feminino , Humanos , Complicações Pós-Operatórias/fisiopatologia , Torsades de Pointes/fisiopatologia
17.
Cardiovasc Toxicol ; 18(3): 242-251, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29139031

RESUMO

Anti-atrial fibrillatory, proarrhythmic and cardiodepressive profiles of dronedarone were analyzed using the halothane-anesthetized beagle dogs (n = 4) to create a standard protocol for clarifying both efficacy and adverse effects of anti-atrial fibrillatory drugs. Intravenous administration of dronedarone hydrochloride in doses of 0.3 and 3 mg/kg over 30 s attained the peak plasma concentrations of 61 and 1248 ng/mL, respectively, reflecting sub- to supra-therapeutic ones. The low dose decreased the left ventricular contraction and mean blood pressure, which were enhanced at the high dose. The high dose also decreased the heart rate and cardiac output, but increased the total peripheral resistance and left ventricular end-diastolic pressure, showing its potent cardiodepressive profile. Moreover, the high dose delayed the atrioventricular nodal and intraventricular conductions in addition to the ventricular repolarization, suggesting its inhibitory action on the Ca2+, Na+ and K+ channels in the in situ heart, respectively. The high dose also prolonged the effective refractory period 1.9 times greater in the atrium than in the ventricle, explaining its clinically demonstrated efficacy against the atrial arrhythmias. Dronedarone significantly prolonged the Tpeak-Tend in a dose-related manner with a tendency to prolong the terminal repolarization period and J-Tpeakc, indicating considerable risk to induce torsade de pointes. No significant change was detected in the P-wave duration by either dose, indicating the lack of effect on the atrial Na+ channel in vivo. The current experimental protocol and the results of dronedarone can be used as a guide for safety pharmacological evaluation of new anti-atrial fibrillatory drugs.


Assuntos
Antiarrítmicos/farmacologia , Antiarrítmicos/toxicidade , Fibrilação Atrial/tratamento farmacológico , Dronedarona/farmacologia , Dronedarona/toxicidade , Sistema de Condução Cardíaco/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Torsades de Pointes/induzido quimicamente , Potenciais de Ação/efeitos dos fármacos , Animais , Antiarrítmicos/sangue , Fibrilação Atrial/sangue , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Débito Cardíaco/efeitos dos fármacos , Modelos Animais de Doenças , Cães , Dronedarona/sangue , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Masculino , Período Refratário Eletrofisiológico , Medição de Risco , Fatores de Tempo , Torsades de Pointes/sangue , Torsades de Pointes/diagnóstico , Torsades de Pointes/fisiopatologia , Função Ventricular Esquerda/efeitos dos fármacos , Pressão Ventricular/efeitos dos fármacos
18.
Curr Drug Metab ; 19(8): 641-652, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29283067

RESUMO

BACKGROUND: Antidepressants have been widely prescribed for depression, anxiety, sleep disorders, and in the management of behavioural symptoms of adult-old patients. Although generally safe, newer generation antidepressants are not devoid of the risk of inducing clinically relevant adverse events. OBJECTIVES: To investigate the association between newer generation antidepressants and the occurrence of cardiovascular adverse events and electrocardiogram (ECG) abnormalities. METHOD: Studies were included in the review according to the following criteria: a) clinical trials (placebo-controlled or not) or case reports; b) short- or long-term interventions with antidepressants; c) prescription of newer generation antidepressants as first-line treatment; d) samples of adult or adult-old patients. From a total of 301 articles addressing the association between antidepressants and cardiovascular adverse events as primary or secondary outcomes, we selected 30 controlled clinical trials and 10 case reports. RESULTS: In most clinical studies, the effects of antidepressants on cardiac function are usually computed as secondary outcome variables, however with limited information. Conversely, case reports tend to present more comprehensive sets of clinical and laboratorial parameters, but the generalization of such data is limited by the small number of observations. The occurrence of QTc prolongation (with increased risk of torsade de pointes) has been reported. Aging, higher dosages of antidepressants, drug interaction, and pre-existing cardiovascular comorbidities were found as risk factors for the aforementioned cardiovascular and ECG abnormalities. CONCLUSION: Prescribing antidepressants requires caution given their potential impact on cardiac function, and the clinician should carefully monitor cardiovascular and ECG parameters particularly in cases with underlying heart disease.


Assuntos
Antidepressivos/efeitos adversos , Coração/efeitos dos fármacos , Síndrome do QT Longo/induzido quimicamente , Transtornos Mentais/tratamento farmacológico , Torsades de Pointes/induzido quimicamente , Relação Dose-Resposta a Droga , Interações de Medicamentos , Eletrocardiografia , Humanos , Síndrome do QT Longo/diagnóstico , Fatores de Risco , Torsades de Pointes/diagnóstico
19.
Clin Pharmacol Ther ; 103(2): 304-309, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29219167

RESUMO

Several risk factors for development of a potentially fatal ventricular arrhythmia, torsade de pointes, have been observed, including female gender. However, in most investigations, only few torsade events were included and/or rarely were postdose heart rate corrected QT (QTc) measurements included, as a surrogate of drug exposure. We developed a multivariate logistic regression model using data from 22,214 patients (33% women) with 84 torsade events (56% women) to evaluate the relationship between risk factors for torsade using data from four anti-arrhythmic drug development programs. Before model development, we evaluated different QT/QTc postdose metrics (average, maximum, etc.) to determine which QT metric should be included into the model. The developed multivariate model showed that, after accounting for known risk factors for torsade and postdose QTc, that female gender remained a significant risk factor for torsade.


Assuntos
Antiarrítmicos/efeitos adversos , Desenvolvimento de Medicamentos/métodos , Descoberta de Drogas/métodos , Sistema de Condução Cardíaco/efeitos dos fármacos , Torsades de Pointes/induzido quimicamente , Potenciais de Ação/efeitos dos fármacos , Idoso , Mineração de Dados/métodos , Bases de Dados Factuais , Medicina Baseada em Evidências/métodos , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Segurança do Paciente , Medição de Risco , Fatores de Risco , Fatores Sexuais , Torsades de Pointes/diagnóstico , Torsades de Pointes/fisiopatologia
20.
J Electrocardiol ; 51(1): 108-110, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29126547

RESUMO

We present the case of a 62-year-old woman with levofloxacin-induced Torsade de Pointes, in whom microvolt T-wave alternans was measured during acute hospitalization and when QT interval was dynamically changing, illustrating a means for monitoring proarrhythmia.


Assuntos
Antibacterianos/efeitos adversos , Eletrocardiografia , Levofloxacino/efeitos adversos , Torsades de Pointes/diagnóstico , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Bisoprolol/uso terapêutico , Feminino , Humanos , Síndrome do QT Longo/diagnóstico , Pessoa de Meia-Idade , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/tratamento farmacológico
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