Difference between revisions of "QT prolongation"

Line 1: Line 1:
 
==Diagnosis==
 
==Diagnosis==
QTc >440 (male) & >460 (female)
+
*QTc >440 (male), >460 (female)
 
+
*>500 = real concern (may result in torsades)
>500 = real concern
 
 
 
^May result in torsades!
 
  
 
==DDX==
 
==DDX==
 
#Pause Dependent (Aquired)
 
#Pause Dependent (Aquired)
##Drug induced*
+
##Drug induced
###antidyrhythmics
+
###Antidyrhythmics
###phenothiazines
+
###Phenothiazines
 
###TCAs
 
###TCAs
###organophosphates
+
###Organophosphates
###antihistamines
+
###Antihistamines
 
##Electrolyte abnl (hypoKalemia, hypoMag, hypoCa)
 
##Electrolyte abnl (hypoKalemia, hypoMag, hypoCa)
 
##Diet related (starvation, low protein)
 
##Diet related (starvation, low protein)
Line 37: Line 34:
 
##Unstable/sustained torsades--> unsynch countershock
 
##Unstable/sustained torsades--> unsynch countershock
 
##Stable
 
##Stable
###treat underlying prob
+
###Treat underlying prob
###increase HR (isoproterenol or overdrive pacing ~100-120bt/min)
+
###Increase HR (isoproterenol or overdrive pacing
###magnesium sulfated IV
+
###Magnesium sulfate IV
###may 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==
 
==Drug List==
amiodarone
+
#Antiarrhythmics
 
+
##Amiodarone, disopyramide, dofetilide, flecainide, ibutilide, mexiletine, procainamide, quinidine, sotalol
aresenic trioxide
+
#Antibiotics
 
+
##Macrolide
bepridil
+
###Azithromycin, erythromycin, clarithromycin
 
+
##Fluoroquinolone
beta agonists
+
###Ciprofloxacin, gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin, ofloxacin
 
+
##Other
chloroquine
+
###Pentamidine, telithromycin, trimethoprim-sulfamethoxazole
 
+
#Antidepressants
cisapride
+
##Amitriptyline, citalopram, doxepin, fluoxetine, nortriptyline, paroxetine, sertraline, venlafaxine
 
+
#Antiemetics
clarithromycin
+
##Dolasetron, droperidol, granisetron, ondansetron
 
+
#Antifungals
disopyramide
+
##Fluconazole, itraconazole, ketoconazole, voriconazole
 
+
#Antihypertensives
dofetilde
+
##Nicardipine
 
+
#Antineoplastics
dolasetron
+
##Lapatinib, nilotinib, sunitinib, tamoxifen
 
+
#Antimalarials
droperidol
+
##Chloroquine, halofantrine
 
+
#Antipsychotics
erythromycin
+
##Chlorpromazine, clozapine, galantamine, haloperidol, lithium, paliperidone, pimozide, quetiapine, risperidone, thioridazine, ziprasidone
 
+
#Antivirals
flecainide
+
##Amantadine, atazanavir, foscarnet
 
+
#Diuretics
fluoxetine
+
##Indapamide
 
+
#Immune suppressants
foscarnet
+
##Tacrolimus
 
+
#Opiates
fosphenytoin
+
##Methadone
 
+
#Phosphodiesterase inhibitors
gatifloxacin
+
##Sildenafil, vardenafil
 
+
#Skeletal muscle relaxants
haloperidol
+
##Tizanidine
 
+
#Urinary antispasmodics
ibutilide
+
##Solifenacin
 
 
indapamide
 
 
 
isradipine
 
 
 
levofloxacin
 
 
 
levomethadyl
 
 
 
mefloquine
 
 
 
moexipril
 
 
 
moxifloxacin
 
 
 
naratriptan
 
 
 
nicardipine
 
 
 
octreaotide
 
 
 
pentamidine
 
 
 
phenothiazines
 
 
 
pimozide
 
 
 
procainamide
 
 
 
quetiapine
 
 
 
quinidine
 
 
 
quinine
 
 
 
reisperidone
 
 
 
sertraline
 
 
 
sotalol
 
 
 
sparfloxacin
 
 
 
sumatriptan
 
 
 
tamoxifen
 
 
 
tizanidine
 
 
 
TCAs
 
 
 
venlafazine
 
 
 
ziprasidone
 
 
 
thioridazine>ziprasidone>risperidone>haloperidol
 
  
 
==Source ==
 
==Source ==
2/14/06 DONALDSON (adapted from Rosen, Pharmacopia, qtdugs.org)
+
*Rosen
 +
*Tintinalli
  
 
[[Category:Cards]]
 
[[Category:Cards]]
 
[[Category:Tox]]
 
[[Category:Tox]]

Revision as of 08:13, 20 December 2011

Diagnosis

  • QTc >440 (male), >460 (female)
  • >500 = real concern (may result in torsades)

DDX

  1. Pause Dependent (Aquired)
    1. Drug induced
      1. Antidyrhythmics
      2. Phenothiazines
      3. TCAs
      4. Organophosphates
      5. Antihistamines
    2. Electrolyte abnl (hypoKalemia, hypoMag, hypoCa)
    3. Diet related (starvation, low protein)
    4. Severe bradycardia/AV block
    5. Hypothyroid
    6. Contrast injection
    7. CVA (intraparenchymal)
    8. MI
  2. Adrenergic Dependent
    1. Congenital
      1. Jarvel/Lange-Nielsen
        1. (+deafness; AR)
      2. Romano-Ward synd
        1. (nl hearing; AD)
      3. Sporatic
      4. Mitral valve prolapse
    2. Acquired
      1. CVA (subarachnoid)
      2. Autonomic surg (catechol excess: neck dissection, carotid endarterect, truncal vagotomy)

Treatment

  1. Pause Dependent (precipitated by bradycard)
    1. Unstable/sustained torsades--> unsynch countershock
    2. Stable
      1. Treat underlying prob
      2. Increase HR (isoproterenol or overdrive pacing
      3. Magnesium sulfate IV
      4. Consider amiodarone
  2. Adrenergic Dependent (precipited by tachycardia)
    1. Unstable/sustained torsades--> unsynch countershock
    2. Stable
      1. slow HR (B-blockers)
      2. May consider magnesium

Drug List

  1. Antiarrhythmics
    1. Amiodarone, disopyramide, dofetilide, flecainide, ibutilide, mexiletine, procainamide, quinidine, sotalol
  2. Antibiotics
    1. Macrolide
      1. Azithromycin, erythromycin, clarithromycin
    2. Fluoroquinolone
      1. Ciprofloxacin, gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin, ofloxacin
    3. Other
      1. Pentamidine, telithromycin, trimethoprim-sulfamethoxazole
  3. Antidepressants
    1. Amitriptyline, citalopram, doxepin, fluoxetine, nortriptyline, paroxetine, sertraline, venlafaxine
  4. Antiemetics
    1. Dolasetron, droperidol, granisetron, ondansetron
  5. Antifungals
    1. Fluconazole, itraconazole, ketoconazole, voriconazole
  6. Antihypertensives
    1. Nicardipine
  7. Antineoplastics
    1. Lapatinib, nilotinib, sunitinib, tamoxifen
  8. Antimalarials
    1. Chloroquine, halofantrine
  9. Antipsychotics
    1. Chlorpromazine, clozapine, galantamine, haloperidol, lithium, paliperidone, pimozide, quetiapine, risperidone, thioridazine, ziprasidone
  10. Antivirals
    1. Amantadine, atazanavir, foscarnet
  11. Diuretics
    1. Indapamide
  12. Immune suppressants
    1. Tacrolimus
  13. Opiates
    1. Methadone
  14. Phosphodiesterase inhibitors
    1. Sildenafil, vardenafil
  15. Skeletal muscle relaxants
    1. Tizanidine
  16. Urinary antispasmodics
    1. Solifenacin

Source

  • Rosen
  • Tintinalli