Difference between revisions of "QT prolongation"

m (Rossdonaldson1 moved page QT Prolongation to QT prolongation)
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==Differential Diagnosis==
 
==Differential Diagnosis==
#Pause Dependent (Aquired)
+
*Pause Dependent (Aquired)
##Drug induced
+
**Drug induced
###Antidyrhythmics
+
***Antidyrhythmics
###Phenothiazines
+
***Phenothiazines
###[[TCAs]]
+
***[[TCAs]]
###[[Organophosphates]]
+
***[[Organophosphates]]
###Antihistamines
+
***Antihistamines
##[[Electrolyte Abnormalities]] ([[hypoKalemia]], [[hypoMag]], [[hypoCa]])
+
**[[Electrolyte Abnormalities]] ([[hypoKalemia]], [[hypoMag]], [[hypoCa]])
##Diet related (starvation, low protein)
+
**Diet related (starvation, low protein)
##[[Severe Bradycardia]]/AV Block
+
**[[Severe Bradycardia]]/AV Block
##[[Hypothyroid]]
+
**[[Hypothyroid]]
##Contrast injection
+
**Contrast injection
##[[CVA]] (intraparenchymal)
+
**[[CVA]] (intraparenchymal)
##[[MI]]
+
**[[MI]]
#Adrenergic Dependent
+
*Adrenergic Dependent
##Congenital
+
**Congenital
###Jarvel/Lange-Nielsen
+
***Jarvel/Lange-Nielsen
####(+deafness; AR)
+
****(+deafness; AR)
###Romano-Ward synd
+
***Romano-Ward synd
####(nl hearing; AD)
+
****(nl hearing; AD)
###Sporatic
+
***Sporatic
###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)
 +
 
 +
===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)
+
*Pause Dependent (precipitated by bradycard)
##Unstable/sustained torsades--> unsynch countershock
+
**Unstable/sustained torsades--> unsynch countershock
##Stable
+
**Stable
###Treat underlying prob
+
***Treat underlying prob
###Increase HR (isoproterenol or overdrive pacing
+
***Increase HR (isoproterenol or overdrive pacing
###Magnesium sulfate IV
+
***Magnesium sulfate IV
###Consider amiodarone
+
***Consider amiodarone
#Adrenergic Dependent (precipited by tachycardia)
+
*Adrenergic Dependent (precipited by tachycardia)
##Unstable/sustained torsades--> unsynch countershock
+
**Unstable/sustained torsades--> unsynch countershock
##Stable
+
**Stable
###Slow HR (B-blockers)
+
***Slow HR (B-blockers)
###May consider magnesium
+
***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
 
#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==
 
==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)
  • 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

  • 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

External Links

Amal Mattu's Case of the Week (10/13/2014)