QT prolongation: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Pause Dependent (Aquired) | |||
**Drug induced | |||
***Antidyrhythmics | |||
***Phenothiazines | |||
***[[TCAs]] | |||
***[[Organophosphates]] | |||
***Antihistamines | |||
**[[Electrolyte Abnormalities]] ([[hypoKalemia]], [[hypoMag]], [[hypoCa]]) | |||
**Diet related (starvation, low protein) | |||
**[[Severe Bradycardia]]/AV Block | |||
**[[Hypothyroid]] | |||
**Contrast injection | |||
**[[CVA]] (intraparenchymal) | |||
**[[MI]] | |||
*Adrenergic Dependent | |||
**Congenital | |||
***Jarvel/Lange-Nielsen | |||
****(+deafness; AR) | |||
***Romano-Ward synd | |||
****(nl hearing; AD) | |||
***Sporatic | |||
***Mitral valve prolapse | |||
**Acquired | |||
***[[CVA]] (subarachnoid) | |||
***Autonomic surg (catechol excess: neck dissection, carotid endarterect, truncal vagotomy) | |||
===Drug List=== | |||
*Antiarrhythmics | |||
**Amiodarone, disopyramide, dofetilide, flecainide, ibutilide, mexiletine, procainamide, quinidine, sotalol | |||
*Antibiotics | |||
**Macrolide | |||
***Azithromycin, erythromycin, clarithromycin | |||
**Fluoroquinolone | |||
***Ciprofloxacin, gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin, ofloxacin | |||
**Other | |||
***Pentamidine, telithromycin, trimethoprim-sulfamethoxazole | |||
*Antidepressants | |||
**Amitriptyline, citalopram, doxepin, fluoxetine, nortriptyline, paroxetine, sertraline, venlafaxine | |||
*Antiemetics | |||
**Dolasetron, droperidol, granisetron, ondansetron | |||
*Antifungals | |||
**Fluconazole, itraconazole, ketoconazole, voriconazole | |||
*Antihypertensives | |||
**Nicardipine | |||
*Antineoplastics | |||
**Lapatinib, nilotinib, sunitinib, tamoxifen | |||
*Antimalarials | |||
**Chloroquine, halofantrine | |||
*Antipsychotics | |||
**Chlorpromazine, clozapine, galantamine, haloperidol, lithium, paliperidone, pimozide, quetiapine, risperidone, thioridazine, ziprasidone | |||
*Antivirals | |||
**Amantadine, atazanavir, foscarnet | |||
*Diuretics | |||
**Indapamide | |||
*Immune suppressants | |||
**Tacrolimus | |||
*Opiates | |||
**Methadone | |||
*Phosphodiesterase inhibitors | |||
**Sildenafil, vardenafil | |||
*Skeletal muscle relaxants | |||
**Tizanidine | |||
*Urinary antispasmodics | |||
**Solifenacin | |||
==Treatment== | ==Treatment== | ||
*Pause Dependent (precipitated by bradycard) | |||
**Unstable/sustained torsades--> unsynch countershock | |||
**Stable | |||
***Treat underlying prob | |||
***Increase HR (isoproterenol or overdrive pacing | |||
***Magnesium sulfate IV | |||
***Consider amiodarone | |||
*Adrenergic Dependent (precipited by tachycardia) | |||
**Unstable/sustained torsades--> unsynch countershock | |||
**Stable | |||
***Slow HR (B-blockers) | |||
***May consider magnesium | |||
==See Also== | ==See Also== | ||
Revision as of 04:59, 25 February 2015
Diagnosis
- QTc >440 (male), >460 (female)
- >500 = real concern (may result in torsades)
Differential Diagnosis
- Pause Dependent (Aquired)
- Drug induced
- Antidyrhythmics
- Phenothiazines
- TCAs
- Organophosphates
- Antihistamines
- Electrolyte Abnormalities (hypoKalemia, hypoMag, hypoCa)
- Diet related (starvation, low protein)
- Severe Bradycardia/AV Block
- Hypothyroid
- Contrast injection
- CVA (intraparenchymal)
- MI
- Drug induced
- Adrenergic Dependent
- Congenital
- Jarvel/Lange-Nielsen
- (+deafness; AR)
- Romano-Ward synd
- (nl hearing; AD)
- Sporatic
- Mitral valve prolapse
- Jarvel/Lange-Nielsen
- Acquired
- CVA (subarachnoid)
- Autonomic surg (catechol excess: neck dissection, carotid endarterect, truncal vagotomy)
- Congenital
Drug List
- Antiarrhythmics
- Amiodarone, disopyramide, dofetilide, flecainide, ibutilide, mexiletine, procainamide, quinidine, sotalol
- Antibiotics
- Macrolide
- Azithromycin, erythromycin, clarithromycin
- Fluoroquinolone
- Ciprofloxacin, gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin, ofloxacin
- Other
- Pentamidine, telithromycin, trimethoprim-sulfamethoxazole
- Macrolide
- Antidepressants
- Amitriptyline, citalopram, doxepin, fluoxetine, nortriptyline, paroxetine, sertraline, venlafaxine
- Antiemetics
- Dolasetron, droperidol, granisetron, ondansetron
- Antifungals
- Fluconazole, itraconazole, ketoconazole, voriconazole
- Antihypertensives
- Nicardipine
- Antineoplastics
- Lapatinib, nilotinib, sunitinib, tamoxifen
- Antimalarials
- Chloroquine, halofantrine
- Antipsychotics
- Chlorpromazine, clozapine, galantamine, haloperidol, lithium, paliperidone, pimozide, quetiapine, risperidone, thioridazine, ziprasidone
- Antivirals
- Amantadine, atazanavir, foscarnet
- Diuretics
- Indapamide
- Immune suppressants
- Tacrolimus
- Opiates
- Methadone
- Phosphodiesterase inhibitors
- Sildenafil, vardenafil
- Skeletal muscle relaxants
- Tizanidine
- Urinary antispasmodics
- Solifenacin
Treatment
- Pause Dependent (precipitated by bradycard)
- Unstable/sustained torsades--> unsynch countershock
- Stable
- Treat underlying prob
- Increase HR (isoproterenol or overdrive pacing
- Magnesium sulfate IV
- Consider amiodarone
- Adrenergic Dependent (precipited by tachycardia)
- Unstable/sustained torsades--> unsynch countershock
- Stable
- Slow HR (B-blockers)
- May consider magnesium
See Also
Source
- Rosen
- Tintinalli