Difference between revisions of "QT prolongation"

(Drug List)
(Drug List)
Line 72: Line 72:
 
*Antivirals
 
*Antivirals
 
**[[Amantadine]], atazanavir, [[foscarnet]]
 
**[[Amantadine]], atazanavir, [[foscarnet]]
*Diuretics
+
*[[Diuretics]]
 
**Indapamide
 
**Indapamide
 
*Immune suppressants
 
*Immune suppressants
 
**[[Tacrolimus]]
 
**[[Tacrolimus]]
*Opiates
+
*[[Opiates]]
 
**[[Methadone]]
 
**[[Methadone]]
 
*Phosphodiesterase inhibitors
 
*Phosphodiesterase inhibitors

Revision as of 13:06, 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