QT prolongation: Difference between revisions
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== | ==Background== | ||
==Clinical Features== | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 71: | Line 71: | ||
*Urinary antispasmodics | *Urinary antispasmodics | ||
**Solifenacin | **Solifenacin | ||
==Diagnosis== | |||
*[[ECG]] | |||
**QTc >440 (male), >460 (female) | |||
**>500 = real concern (may result in [[torsades]]) | |||
==Management== | ==Management== | ||
===Pause Dependent (precipitated by | ===Pause Dependent (precipitated by bradycardia)=== | ||
*Unstable/sustained [[torsades]]--> [[defibrilation]] (unsynchronized) | *Unstable/sustained [[torsades]]--> [[defibrilation]] (unsynchronized) | ||
*Stable | *Stable | ||
| Line 86: | Line 91: | ||
**Slow HR ([[B-blockers]]) | **Slow HR ([[B-blockers]]) | ||
**May consider [[magnesium sulfate]] | **May consider [[magnesium sulfate]] | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
Revision as of 05:25, 11 July 2016
Background
Clinical Features
Differential Diagnosis
- Pause Dependent (Aquired)
- Drug induced
- Antidyrhythmics
- Phenothiazines
- TCAs
- Organophosphates
- Antihistamines
- Electrolyte Abnormalities (hypoKalemia, hypoMag, hypoCa)
- Hypokalemia triad
- Long QT, ST depressions, PVCs
- Hypokalemia triad
- Diet related (starvation, low protein)
- Severe Bradycardia/AV Block
- Hypothyroid
- Contrast injection
- CVA (intraparenchymal)
- Elevated intracranial pressure and Intracranial hemorrhage
- 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
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
Diagnosis
Management
Pause Dependent (precipitated by bradycardia)
- Unstable/sustained torsades--> defibrilation (unsynchronized)
- Stable
- Treat underlying prob
- Increase HR (isoproterenol or overdrive pacing)
- Magnesium sulfate IV
- Consider amiodarone
Adrenergic Dependent (precipited by tachycardia)
- Unstable/sustained torsades--> defibrilation (unsynchronized)
- Stable
- Slow HR (B-blockers)
- May consider magnesium sulfate