QT prolongation: Difference between revisions
(→Source) |
(→DDX) |
||
Line 8: | Line 8: | ||
###Antidyrhythmics | ###Antidyrhythmics | ||
###Phenothiazines | ###Phenothiazines | ||
###TCAs | ###[[TCAs]] | ||
###Organophosphates | ###[[Organophosphates]] | ||
###Antihistamines | ###Antihistamines | ||
##Electrolyte | ##[[Electrolyte Abnormalities]] ([[hypoKalemia]], [[hypoMag]], [[hypoCa]]) | ||
##Diet related (starvation, low protein) | ##Diet related (starvation, low protein) | ||
##Severe | ##[[Severe Bradycardia]]/[[AV Block]] | ||
##Hypothyroid | ##[[Hypothyroid]] | ||
##Contrast injection | ##Contrast injection | ||
##CVA (intraparenchymal) | ##[[CVA]] (intraparenchymal) | ||
##MI | ##[[MI]] | ||
#Adrenergic Dependent | #Adrenergic Dependent | ||
##Congenital | ##Congenital | ||
Line 27: | Line 27: | ||
###Mitral valve prolapse | ###Mitral valve prolapse | ||
##Acquired | ##Acquired | ||
###CVA (subarachnoid) | ###[[CVA]] (subarachnoid) | ||
###Autonomic surg (catechol excess: neck dissection, carotid endarterect, truncal vagotomy) | ###Autonomic surg (catechol excess: neck dissection, carotid endarterect, truncal vagotomy) | ||
Revision as of 06:01, 5 February 2014
Diagnosis
- QTc >440 (male), >460 (female)
- >500 = real concern (may result in torsades)
DDX
- 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
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
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
See Also
Source
- Rosen
- Tintinalli