Difference between revisions of "QT prolongation"

(Evaluation)
(Drug List)
Line 49: Line 49:
 
*Antiarrhythmics
 
*Antiarrhythmics
 
**[[Amiodarone]], disopyramide, dofetilide, [[flecainide]], ibutilide, mexiletine, [[procainamide]], [[quinidine]], [[sotalol]]
 
**[[Amiodarone]], disopyramide, dofetilide, [[flecainide]], ibutilide, mexiletine, [[procainamide]], [[quinidine]], [[sotalol]]
*Antibiotics
+
*[[Antibiotics ]]
**Macrolide
+
**[[Macrolide]]
 
***[[Azithromycin]], [[erythromycin]], [[clarithromycin]]
 
***[[Azithromycin]], [[erythromycin]], [[clarithromycin]]
**Fluoroquinolone
+
**[[Fluoroquinolone]]
 
***[[Ciprofloxacin]], gatifloxacin (most common), [[gemifloxacin]], [[levofloxacin]], [[moxifloxacin]], [[ofloxacin]]
 
***[[Ciprofloxacin]], gatifloxacin (most common), [[gemifloxacin]], [[levofloxacin]], [[moxifloxacin]], [[ofloxacin]]
 
**Other
 
**Other
 
***[[Pentamidine]], telithromycin, [[trimethoprim-sulfamethoxazole]]
 
***[[Pentamidine]], telithromycin, [[trimethoprim-sulfamethoxazole]]
*Antidepressants
+
*[[Antidepressants]]
 
**[[Amitriptyline]], citalopram, [[doxepin]], fluoxetine, [[nortriptyline]], paroxetine, sertraline, [[venlafaxine]]
 
**[[Amitriptyline]], citalopram, [[doxepin]], fluoxetine, [[nortriptyline]], paroxetine, sertraline, [[venlafaxine]]
*Antiemetics
+
*[[Antiemetics]]
 
**Dolasetron, [[droperidol]], granisetron, [[ondansetron]]
 
**Dolasetron, [[droperidol]], granisetron, [[ondansetron]]
 
*Antifungals
 
*Antifungals

Revision as of 13:00, 30 March 2019

Background

  • Prolonged ventricular repolarisation → increased risk of ventricular arrythmias
    • Males >440-450 ms
    • Females >500 ms
    • Rule of thumb: Normal QT interveal is less than half of preceding RR interval
  • QT interval is from the beginning of the Q wave to the end of the T wave
    • Rate dependent and should become proportionately shorter with increasing heart rate

Clinical Features

  • Most are asymptomatic
  • History may include:
  • Medication history may include QT prolonging medications

Differential Diagnosis

Drug List

Evaluation

Workup

  • ECG
  • CBC
  • Chem 10

Diagnosis

Acquired QT prolongation
  • ECG
    • On visual inspection, QT takes up more than half the R-R distance
    • Measure QT interval in lead II or V5-6
    • QTc = QT /√R-R

Management

Pause Dependent (precipitated by bradycardia)

Adrenergic Dependent (precipited by tachycardia)

Disposition

  • Consider admission, especially for QT >500 or if symptomatic
  • May require consultation for discontinuation of QT prolonging medications
  • Avoid prescribing medications that may contribute to prolonged QT

See Also

External Links

References