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1.
Methods Mol Biol ; 2320: 151-160, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34302656

RESUMO

Human-induced pluripotent stem cell (iPSC) technology paves the way for next-generation drug-safety assessment. In particular, human iPSC-derived cardiomyocytes, which exhibit electrical activity, are useful as a human cell model for assessing QT-interval prolongation and the risk of the lethal arrhythmia Torsade de Pointes (TdP). In addition to proarrhythmia assay, contractile behavior has received increased attention in drug development. In this study, we developed a novel high-throughput in vitro assay system using motion vectors to evaluate the contractile activity of iPSC-derived cardiomyocytes as a physiologically relevant human platform. The methods presented here highlight the use of commercially available iPSC-derived cardiomyocytes, iCell cardiomyocytes, for contractility evaluation recorded by the motion vector system.


Assuntos
Bioensaio/métodos , Células-Tronco Pluripotentes Induzidas/citologia , Miócitos Cardíacos/citologia , Arritmias Cardíacas/terapia , Células Cultivadas , Humanos , Síndrome do QT Longo/terapia , Torsades de Pointes/terapia
2.
Intern Med ; 60(20): 3257-3260, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33896871

RESUMO

An 82-year-old woman was admitted to our hospital because of dyspnea and bradycardia during exertion. Electrocardiography revealed complete atrioventricular block. During pacemaker implantation, a small dose (12.5 mg) of hydroxyzine was injected for sedation, and torsade de pointes (Tdp) occurred. The QT interval was prolonged after administration of hydroxyzine, and Tdp was observed after the R on T phenomenon occurred, indicating that hydroxyzine was capable of prolonging the QT interval and causing Tdp. Therefore, we must be cautious when administering hydroxyzine for sedation during surgery, especially in patients with bradycardia.


Assuntos
Bloqueio Atrioventricular , Marca-Passo Artificial , Torsades de Pointes , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/induzido quimicamente , Bloqueio Atrioventricular/diagnóstico , Eletrocardiografia , Feminino , Humanos , Hidroxizina/efeitos adversos , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/diagnóstico , Torsades de Pointes/terapia
3.
BMC Cardiovasc Disord ; 21(1): 136, 2021 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-33711933

RESUMO

BACKGROUND: Abiraterone is a medication frequently used for metastatic castrate-resistant prostate cancer. We report a case of non-sustained episodes of TdP associated with severe hypokalemia due to androgen-deprivation therapy. Few case presentations describe this association; the novelty lies in the potentially lethal cardiovascular events among cancer patients receiving hormonal therapy. CASE PRESENTATION: A 70-year-old male presented with recurrent syncope without prodrome. ECG revealed frequent ventricular ectopy, non-sustained episodes of TdP, and severe hypomagnesemia and hypokalemia. During potassium and magnesium infusion for repletion, the patient underwent temporary transvenous atrial pacing. As part of the work-up, coronary angiography revealed a mild coronary artery disease, and transthoracic echocardiogram showed a moderately depressed ejection fraction. After electrolyte disturbances were corrected, the QT interval normalized, and transvenous pacing was no longer necessary. Abiraterone was discontinued during the admission, and the patient returned to baseline. CONCLUSIONS: Cancer treatment is complex and requires a multidisciplinary approach. We presented a case of non-sustained TdP associated with androgen-deprivation therapy in an elderly patient with mild coronary artery disease and moderately reduced ejection fraction. Close follow-up and increased awareness are required in patients with hormonal treatment, especially in the setting of other cardiovascular risk factors.


Assuntos
Acetato de Abiraterona/efeitos adversos , Antineoplásicos/efeitos adversos , Frequência Cardíaca/efeitos dos fármacos , Síndrome do QT Longo/induzido quimicamente , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Inibidores da Síntese de Esteroides/efeitos adversos , Síncope/induzido quimicamente , Torsades de Pointes/induzido quimicamente , Idoso , Estimulação Cardíaca Artificial , Hidratação , Humanos , Síndrome do QT Longo/diagnóstico por imagem , Síndrome do QT Longo/fisiopatologia , Síndrome do QT Longo/terapia , Masculino , Síncope/diagnóstico , Síncope/fisiopatologia , Síncope/terapia , Torsades de Pointes/diagnóstico , Torsades de Pointes/fisiopatologia , Torsades de Pointes/terapia , Resultado do Tratamento
4.
Eur J Clin Invest ; 51(2): e13428, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33043453

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide resulting in significant morbidity and mortality. Arrhythmias are prevalent and reportedly, the second most common complication. Several mechanistic pathways are proposed to explain the pro-arrhythmic effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A number of treatment approaches have been trialled, each with its inherent unique challenges. This rapid systematic review aimed to examine the current incidence and available treatment of arrhythmias in COVID-19, as well as barriers to implementation. METHODS: Our search of scientific databases identified relevant published studies from 1 January 2000 until 1 June 2020. We also searched Google Scholar for grey literature. We identified 1729 publications of which 1704 were excluded. RESULTS: The incidence and nature of arrhythmias in the setting of COVID-19 were poorly documented across studies. The cumulative incidence of arrhythmia across studies of hospitalised patients was 6.9%. Drug-induced long QT syndrome secondary to antimalarial and antimicrobial therapy was a significant contributor to arrhythmia formation, with an incidence of 14.15%. Torsades de pointes (TdP) and sudden cardiac death (SCD) were reported. Treatment strategies aim to minimise this through risk stratification and regular monitoring of corrected QT interval (QTc). CONCLUSION: Patients with SARS-CoV-2 are at an increased risk of arrhythmias. Drug therapy is pro-arrhythmogenic and may result in TdP and SCD in these patients. Risk assessment and regular QTc monitoring are imperative for safety during the treatment course. Further studies are needed to guide future decision-making.


Assuntos
Arritmias Cardíacas/etiologia , COVID-19/complicações , Síndrome do QT Longo/induzido quimicamente , Antiarrítmicos/uso terapêutico , Antibacterianos/efeitos adversos , Antimaláricos/efeitos adversos , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/terapia , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/terapia , Flutter Atrial/epidemiologia , Flutter Atrial/etiologia , Flutter Atrial/terapia , Azitromicina/efeitos adversos , Bradicardia/epidemiologia , Bradicardia/etiologia , Bradicardia/terapia , COVID-19/tratamento farmacológico , Estimulação Cardíaca Artificial/métodos , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Cardioversão Elétrica/métodos , Hospitalização , Humanos , Hidroxicloroquina/efeitos adversos , Incidência , Síndrome do QT Longo/epidemiologia , Síndrome do QT Longo/terapia , SARS-CoV-2 , Taquicardia Ventricular/epidemiologia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Torsades de Pointes/epidemiologia , Torsades de Pointes/etiologia , Torsades de Pointes/terapia , Fibrilação Ventricular/epidemiologia , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
5.
BMC Cardiovasc Disord ; 20(1): 344, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703237

RESUMO

BACKGROUND: The clinical symptoms and adverse events caused by pacemaker battery depletion are not uncommon, but it is easy to miss or misdiagnose them clinically. To raise the level of awareness towards this clinical situation, we report two cases. CASE PRESENTATION: We described two cases of pacemaker battery depletion. Case 1 was an 83-year-old male manifesting chest pain and dyspnea. Automatic reprogramming after pacemaker battery depletion resulted in pacemaker syndrome. While case 2 was an 80-year-old female with complete atrioventricular heart block and torsade de pointes, due to complete depletion of pacemaker battery. In addition, we introduce a method that can easily identify the depletion of the pacemaker battery, which has clinical promotion value of a certain degree. CONCLUSIONS: Those cases emphasize that serious morbidity can arise from pacemaker battery depletion, even in the early stages. Therefore, early detection and diagnosis is especially important.


Assuntos
Bloqueio Atrioventricular/etiologia , Dor no Peito/etiologia , Dispneia/etiologia , Fontes de Energia Elétrica/efeitos adversos , Falha de Equipamento , Marca-Passo Artificial/efeitos adversos , Torsades de Pointes/etiologia , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/terapia , Dor no Peito/diagnóstico , Dor no Peito/terapia , Remoção de Dispositivo , Dispneia/diagnóstico , Dispneia/terapia , Evolução Fatal , Feminino , Humanos , Masculino , Torsades de Pointes/diagnóstico , Torsades de Pointes/terapia , Resultado do Tratamento
6.
Mayo Clin Proc ; 95(6): 1213-1221, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32359771

RESUMO

As the coronavirus disease 19 (COVID-19) global pandemic rages across the globe, the race to prevent and treat this deadly disease has led to the "off-label" repurposing of drugs such as hydroxychloroquine and lopinavir/ritonavir, which have the potential for unwanted QT-interval prolongation and a risk of drug-induced sudden cardiac death. With the possibility that a considerable proportion of the world's population soon could receive COVID-19 pharmacotherapies with torsadogenic potential for therapy or postexposure prophylaxis, this document serves to help health care professionals mitigate the risk of drug-induced ventricular arrhythmias while minimizing risk of COVID-19 exposure to personnel and conserving the limited supply of personal protective equipment.


Assuntos
Morte Súbita Cardíaca , Hidroxicloroquina , Síndrome do QT Longo , Lopinavir , Risco Ajustado/métodos , Ritonavir , Torsades de Pointes , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Combinação de Medicamentos , Monitoramento de Medicamentos/métodos , Reposicionamento de Medicamentos/ética , Reposicionamento de Medicamentos/métodos , Eletrocardiografia/métodos , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/mortalidade , Síndrome do QT Longo/terapia , Lopinavir/administração & dosagem , Lopinavir/efeitos adversos , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Ritonavir/administração & dosagem , Ritonavir/efeitos adversos , SARS-CoV-2 , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/mortalidade , Torsades de Pointes/terapia
8.
J Gen Intern Med ; 35(3): 865-873, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31654357

RESUMO

One of the more challenging aspects of ECG interpretation is measurement and interpretation of the QT interval. This interval represents the time taken for the ventricles to completely repolarise after activation. Abnormal prolongation of the QT interval can lead to torsades de pointes, a form of potentially life-threatening polymorphic ventricular tachycardia (VT). Detection of a prolonged QT interval is essential as this can be a reversible problem, particularly in the context of the use of a variety of commonly prescribed medications in the hospital setting. Automated ECG printouts cannot be relied upon to diagnose QT interval prolongation; thus, the onus is on the clinician to identify it. This is a difficult task, as the normal QT interval is typically measured relative to the heart rate. Therefore, the QT interval often requires "correction" for the current heart rate, in order to correctly stratify the risk of torsades de pointes. A wealth of correctional formulae have been derived, but none has proven superior. We present an approach to the ECG in this context, and a step-by-step guide to manually measuring and correcting the QT interval, and an approach to management in common hospital-based clinical scenarios.


Assuntos
Síndrome do QT Longo , Médicos , Torsades de Pointes , Eletrocardiografia , Humanos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/terapia , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/diagnóstico , Torsades de Pointes/terapia
9.
J Clin Pharmacol ; 60(3): 284-294, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31743455

RESUMO

This is an article in the Journal of Clinical Pharmacology's Core Entrustable Professional Activities in Clinical Pharmacology series that discusses drug-induced proarrhythmia and is offered as a teaching aid for medical students and residents. Drugs from diverse pharmacological classes can lead to multiple types of arrhythmias including the polymorphic ventricular tachycardia torsades de pointes (TdP). Although typically occurring in self-limiting bursts with or without associated symptoms, which can range from mild lightheadedness and palpitations to syncope and seizures, TdP can also occasionally progress to ventricular fibrillation and sudden cardiac death. To provide patients with the optimal therapeutic benefits of potentially proarrhythmic drugs, prescribers are responsible for obtaining a good understanding of the compound's benefit-risk properties and perform a judicious assessment of the patient's clinical characteristics and individual risk factors. Dose adjustments and/or additional monitoring of electrocardiograms and electrolyte balances may be appropriate in some cases. This article explains the pharmacological mechanism of action of drug-induced proarrhythmia associated with compounds that prolong the repolarization period, illustrates how this liability is conveyed in a drug's prescribing information (label), details the clinical characteristics of patients most susceptible to this type of proarrhythmia, and describes interventions that can be made if TdP occurs. Three clinical vignettes are provided at the end of the article to highlight the relevance of the preceding discussions.


Assuntos
Arritmias Cardíacas/induzido quimicamente , Prescrições de Medicamentos , Arritmias Cardíacas/terapia , Rotulagem de Medicamentos , Monitoramento de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Educação Médica , Eletrocardiografia , Humanos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/terapia , Educação de Pacientes como Assunto , Medição de Risco , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/terapia
10.
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
11.
J Echocardiogr ; 17(3): 157-161, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30426465

RESUMO

BACKGROUND: The standard approach for urgent trans-venous temporary cardiac pacemaker (TVTP) implantation is fluoroscopy guidance. The delay in activation of the fluoroscopy-room and the transfer of unstable patients may be life-threatening. Echocardiography-guided TP implantation may increase the safety of the patients by obviating the need for in-hospital transfer. We examined the feasibility and safety of echocardiography-guided vs. fluoroscopy-guided TVTP implantation. METHODS: From January 2015 to September 2017 data for consecutive patients who needed emergent TVTP implantation were retrospectively reviewed. Ultrasound-guided TVTP protocol that was introduced in our center in January 2015 involved ultrasound guidance for both central venous access and pacing lead positioning. Access sites included femoral, subclavian, or jugular veins. Electrodes were placed in the right ventricular apex by means of echocardiographic monitoring in intensive care unit or by fluoroscopic guidance. Endpoints were achievement of successful ventricular pacing and procedural complications. RESULTS: Sixty-six patients (17 echocardiography-guided and 49 fluoroscopy-guided) were included. There were no differences in pacing threshold between the echocardiography-guided group and the fluoroscopy-guided group (0.75 ± 0.58 mA vs. 0.57 ± 0.35 mA, p = 0.24). The access site for implantation was femoral vein in 27% for the fluoroscopy-guided vs. none for the echocardiography-guided approach (p = 0.015). One hematoma and one related infection occurred in the fluoroscopy-guided group. The need for electrode repositioning was observed in 1 patient in each group. There were no procedural-related deaths in either group. CONCLUSIONS: Echocardiography-guided temporary cardiac pacing is a feasible and safe alternative to fluoroscopy-guided approach and significantly lowers the need for in-hospital transfer.


Assuntos
Arritmias Cardíacas/terapia , Cateterismo Cardíaco/métodos , Ecocardiografia/métodos , Marca-Passo Artificial , Implantação de Prótese/métodos , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/terapia , Estudos de Casos e Controles , Emergências , Estudos de Viabilidade , Feminino , Fluoroscopia/métodos , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Retrospectivos , Síndrome do Nó Sinusal/terapia , Cirurgia Assistida por Computador , Taquicardia Ventricular/terapia , Torsades de Pointes/terapia
12.
Prensa méd. argent ; 104(7): 337-351, sep2018. graf
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1051007

RESUMO

Se estableció los efectos de la claritromicina sobre el intervalo QT corregido (iQTc) en pacientes gerontes, que requirieron hospitalización por infección respiratoria, mediante registro electrocardiográfico al inicio y al final del tratamiento. Se observó en 61% de los casos un aumento del iQTC (0,04 seg en promedio). No obstante las comorbilidades asociadas, ningún caso evolucionó a taquicardia ventricular polimórfica


The effects of clarithromycin on the corrected QT interval (iQTc) in elderly patients, who required hospitalization due to respiratory infection, were established by electrocardiographic recording at the beginning and at the end of the treatment. An increase in iQTC was observed in all cases (0.04 sec on average). Despite the associated comorbidities, no case evolved to polymorphic ventricular tachycardia


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/complicações , Infecções Respiratórias/complicações , Estudos Prospectivos , Torsades de Pointes/terapia , Taquicardia Ventricular/complicações , Claritromicina/efeitos adversos , Síndrome de Romano-Ward/tratamento farmacológico , Miosinas Ventriculares , Morte Súbita , Eletrocardiografia
13.
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 Físico , 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.
Herzschrittmacherther Elektrophysiol ; 28(2): 169-176, 2017 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-28534204

RESUMO

In patients with ion channel disease the predominant arrhythmias are polymorphic ventricular tachycardias (VT), torsade de pointes tachycardia and ventricular fibrillation (VF). In only extremely rare cases is very rapid monomorphic ventricular tachycardia observed. This is why implantable cardioverter-defibrillators (ICDs) should always be programmed for treatment of VF only with high detection rates to avoid inappropriate discharges. In idiopathic VF and catecholaminergic polymorphic ventricular tachycardia (CPVT), no baseline electrocardiographic abnormalities can be detected, whereas in Brugada syndrome, long QT syndrome, early repolarisation syndrome and Anderson-Tawil syndrome alterations of the baseline ECG are very important to identify patients at risk.


Assuntos
Canais Iônicos/fisiologia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Torsades de Pointes/diagnóstico , Torsades de Pointes/fisiopatologia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia , Desfibriladores Implantáveis , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Prognóstico , Fatores de Risco , Processamento de Sinais Assistido por Computador , Software , Taquicardia Ventricular/classificação , Taquicardia Ventricular/terapia , Torsades de Pointes/classificação , Torsades de Pointes/terapia , Fibrilação Ventricular/classificação , Fibrilação Ventricular/terapia , Complexos Ventriculares Prematuros/classificação , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/terapia
16.
Am J Cardiol ; 119(7): 1124-1125, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-28132684

RESUMO

An 18-year-old woman was found unresponsive by her mother. After the patient spontaneously regained consciousness, an electrocardiogram showed a markedly prolonged QT interval thought to be due to congenital long QT1. An implantable cardioverter defibrillator was placed. After being free of symptoms for 1 year, she spontaneously developed torsades de pointes that was successfully terminated by the defibrillator.


Assuntos
Desfibriladores Implantáveis , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/terapia , Torsades de Pointes/diagnóstico , Torsades de Pointes/terapia , Adolescente , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos
18.
Indian J Pharmacol ; 48(4): 462-465, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27756965

RESUMO

Drug-induced torsades de pointes (TdP) is a rare but potentially fatal adverse effect of commonly prescribed medications including cardiac and noncardiac drugs. Importantly, many drugs have been reported to cause the characteristic Brugada syndrome-linked electrocardiography (ECG) abnormalities and/or (fatal) ventricular tachyarrhythmias. Chlorpheniramine and propranolol have the arrhythmogenic effects reported previously. A review of literature revealed a large number of case reports of chlorpheniramine or propranolol use resulting in QTc prolongation, TdP, or both. However, we wish to report the case of a patient who was treated with a combination of chlorpheniramine and propranolol, whose ECG showed no QT prolongation but who suffered from cardiac arrest due to TdP.


Assuntos
Clorfeniramina/efeitos adversos , Parada Cardíaca/induzido quimicamente , Propranolol/efeitos adversos , Torsades de Pointes/induzido quimicamente , Adulto , Clorfeniramina/administração & dosagem , Clorfeniramina/uso terapêutico , Desfibriladores Implantáveis , Eletrocardiografia , Parada Cardíaca/diagnóstico , Parada Cardíaca/terapia , Humanos , Masculino , Propranolol/administração & dosagem , Propranolol/uso terapêutico , Torsades de Pointes/diagnóstico , Torsades de Pointes/terapia , Resultado do Tratamento
19.
Crit Care Nurs Clin North Am ; 28(3): 317-29, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27484660

RESUMO

Ventricular tachycardias include ventricular tachycardia, ventricular fibrillation, and torsades de pointes; although these rhythms may be benign and asymptomatic, others may be life threatening and lead to increased morbidity and mortality. To optimize patient outcomes, ventricular tachycardias need to be rapidly diagnosed and managed, and often the electrocardiogram (ECG) is the first and only manifestation of a cardiac defect. Understanding of the initial electrocardiographic pattern and subsequent changes can lead to early intervention and an improved outcome. This article describes mechanisms, ECG characteristics, and management of ventricular tachycardias.


Assuntos
Gerenciamento Clínico , Eletrocardiografia/métodos , Torsades de Pointes/diagnóstico , Humanos , Torsades de Pointes/fisiopatologia , Torsades de Pointes/terapia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/terapia
20.
Sports Health ; 8(6): 527-535, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27480102

RESUMO

CONTEXT: The congenital long QT syndrome (LQTS) is an inherited channelopathy known for its electrocardiographic manifestations of QT prolongation and its hallmark arrhythmia, torsades de pointes (TdP). TdP can lead to syncope or sudden death and is often precipitated by triggers such as physical exertion or emotional stress. Given that athletes may be at particular risk for adverse outcomes, those suspected of having LQTS should be evaluated, risk stratified, treated, and receive appropriate counseling by providers with sufficient expertise according to the latest guidelines. EVIDENCE ACQUISITION: The following keywords were used to query MEDLINE and PubMed through 2016: LQTS, LQT1, LQT2, LQT3, long QT, long QTc, prolonged QT, prolonged QTc, QT interval, QTc interval, channelopathy, channelopathies, athletes, torsades de pointes, and sudden cardiac death. Selected articles within this primary search, in addition to relevant references from those articles, were reviewed for relevant information and data. Articles with pertinent information regarding pathophysiology, evaluation, diagnosis, genetic testing, treatment, and guidelines for athletes were included, particularly those published in the prior 2 decades. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: Diagnosis of LQTS involves eliciting the patient's family history, clinical history, and evaluation of electrocardiographic findings. Genetic testing for common mutations can confirm suspected cases. ß-Blockers represent the mainstay of treatment, though interventions such as implantable cardioverter-defibrillator placement or left cardiac sympathetic denervation may be required. Properly evaluated and treated athletes with LQTS have a low risk of cardiac events. CONCLUSION: Detection and management of LQTS in the athletic population is crucial given the possibility of adverse outcomes with the stress of athletic participation. Preparticipation screening examinations should include a thorough clinical and family history. Screening electrocardiograms may display key findings consistent with LQTS while genetic testing can confirm the diagnosis. Formerly considered a strict contraindication to athletic participation, LQTS is now an increasingly manageable entity with proper evaluation and treatment by qualified and experienced providers.


Assuntos
Atletas , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/terapia , Medicina Esportiva , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Eletrocardiografia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Síndrome do QT Longo/complicações , Síndrome do QT Longo/fisiopatologia , Guias de Prática Clínica como Assunto , Medição de Risco , Torsades de Pointes/complicações , Torsades de Pointes/diagnóstico , Torsades de Pointes/fisiopatologia , Torsades de Pointes/terapia
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