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Prolonged QT Interval due to Medication

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1. QT-interval prolongation due to medication found in the preoperative evaluation (PubMed)

QT-interval prolongation due to medication found in the preoperative evaluation QT prolongation is an electrocardiographic change that can lead to lethal arrhythmia. Acquired QT prolongation is known to be caused by drugs and electrolyte abnormalities. We report three cases in which the prolonged QT interval was improved at the time of operation by briefly discontinuing the drugs suspected to have caused the QT prolongation observed on preoperative electrocardiography. The QTc of cases 1, 2 (...) potentially lethal side effects of QT prolongation. For safe oral and maxillofacial surgery, cooperation with medical departments in various fields is important.

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2017 Journal of Dental Anesthesia and Pain Medicine

2. Prolonged QT Interval due to Medication

Prolonged QT Interval due to Medication Prolonged QT Interval due to Medication Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Prolonged QT Interval due to Medication Prolonged QT Interval due to Medication Aka: Prolonged QT Interval due to Medication , Drug-Induced Torsades de Pointes From Related Chapters II. Risk Factors: Medication-Induced Torsades de Pointes Female gender Elderly Severe Hepatic or renal dysfunction recently Concurrent use Concurrent use Baseline or subclinical Multiple concurrent agents that prolong QT Rapid infusion of agents known to cause Higher doses of predisposing drug raise risk III. Causes

2018 FP Notebook

3. Can laypeople identify a drug-induced QT interval prolongation? A psychophysical and eye-tracking experiment examining the ability of nonexperts to interpret an ECG. (PubMed)

Can laypeople identify a drug-induced QT interval prolongation? A psychophysical and eye-tracking experiment examining the ability of nonexperts to interpret an ECG. The study sought to quantify a layperson's ability to detect drug-induced QT interval prolongation on an electrocardiogram (ECG) and determine whether the presentation of the trace affects such detection.Thirty layperson participants took part in a psychophysical and eye-tracking experiment. Following training, participants (...) -monitor, which may help with more rapid identification of drug-induced long QT syndrome and prevent the development of life-threatening complications. The rhythm strip is a better form of presentation than a single complex, as it is less likely to be misinterpreted due to artifacts in the signal.© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association.

2019 Journal of the American Medical Informatics Association

4. An Integrative Data Science Pipeline to Identify Novel Drug Interactions that Prolong the QT Interval (PubMed)

outperformed a direct evidence control model in the detection of established interactions (p = 1.62E-3) and significantly enriched for validated QT-DDIs in the EHR (p = 0.01). Of 889 pairs flagged in FAERS, eight novel QT-DDIs were significantly associated with prolonged QTc intervals in the EHR and were not due to co-prescribed medications.Latent signal detection in FAERS validated using the EHR presents an automated and data-driven approach for systematically identifying novel QT-DDIs. The high (...) An Integrative Data Science Pipeline to Identify Novel Drug Interactions that Prolong the QT Interval Drug-induced prolongation of the QT interval on the electrocardiogram (long QT syndrome, LQTS) can lead to a potentially fatal ventricular arrhythmia known as torsades de pointes (TdP). Over 40 drugs with both cardiac and non-cardiac indications are associated with increased risk of TdP, but drug-drug interactions contributing to LQTS (QT-DDIs) remain poorly characterized. Traditional methods

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2016 Drug Safety

5. Nothing QT (Cute) about it: rethinking the use of the QT interval to evaluate risk of drug induced arrhythmias

that it is an arrhythmia caused by prolongation of the QT interval. The more savvy medical student will implicate the corrected QT interval (QTC) and recite a fancy formula with a square root sign to determine this value. Suffice to say, the mystic nature of torsades des pointes and the negative attitude towards QT prolongation have been closely intertwined over the years. While the most common culprits, [1] have become maligned for this reason, there are many more that do not even make it to the market because (...) , and a new, more comprehensive approach should be considered. Aneesh Bapat is a 4th year medical student at NYU Langone Medical Center Peer reviewed by Neil Bernstein, MD, Departments of Medicine (Cardio Div) and Pediatrics, NYU Langone Medical Center Image courtesy of Wikimedia Commons References: 1. Darpo B. Spectrum of drugs prolonging QT interval and the incidence of torsades de pointes. European Heart Journal Supplements. 2001;3:K70-K80. Available at: . 2. Kannankeril P, Roden DM, Darbar D. Drug

2012 Clinical Correlations

6. Effect of Grapefruit on QT Interval in Healthy Volunteers and Patients With Congenital Long QT Syndrome

Update Posted : February 15, 2018 Sponsor: Tel-Aviv Sourasky Medical Center Collaborator: Tel Aviv Medical Center Information provided by (Responsible Party): michal roll, Tel-Aviv Sourasky Medical Center Study Details Study Description Go to Brief Summary: The list of medications that prolong the QT interval and can provoke torsade de pointes keeps expanding. This list includes not only antiarrhythmic drugs, but also medications with no cardiac indications. All these medications prolong the QT (...) develop torsade de pointes from non-cardiac medications have identifiable risk factors. In this regard, patients with a congenital long QT syndrome are prone to develop torsade de pointes when treated with QT-prolonging medications. This is because, due to their genetically defective ion channels, patients with Long QT Syndrome (LQTS) have impaired ventricular repolarization and reduced "repolarization reserve." Therefore, it is common medical practice to strongly advise patients with congenital LQTS

2016 Clinical Trials

7. ECG Quiz Answer – First degree AV block, sinus pause, QT prolongation

(atrioventricular and sinoatrial node) dysfunction. An interesting finding is the recovery of AV conduction after the long pause so that PR interval in the beat following the pause is only 120 ms. QT interval is 440 ms with a cycle length of 640 ms, indicating a QTc of around 550 ms. It may be noted that the QT prolongation is predominantly due to prolongation of ST segment. ST prolongation contributing to QT prolongation is characteristic of hypocalcemia. This is because calcium is the ion predominantly (...) ECG Quiz Answer – First degree AV block, sinus pause, QT prolongation ECG Quiz Answer – First degree AV block, sinus pause, QT prolongation – All About Cardiovascular System and Disorders Now Trending: | April 20, 2018 | , | ECG Quiz Answer – First degree AV block, sinus pause, QT prolongation First degree AV block, sinus pause, QT prolongation: PR interval is prolonged and measures 240 ms. A sinus pause of 1880 ms is seen at the end of the tracing. Together these indicate dual nodal

2018 Cardiophile MD blog

8. Prolonged QT Interval due to Medication

Prolonged QT Interval due to Medication Prolonged QT Interval due to Medication Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Prolonged QT Interval due to Medication Prolonged QT Interval due to Medication Aka: Prolonged QT Interval due to Medication , Drug-Induced Torsades de Pointes From Related Chapters II. Risk Factors: Medication-Induced Torsades de Pointes Female gender Elderly Severe Hepatic or renal dysfunction recently Concurrent use Concurrent use Baseline or subclinical Multiple concurrent agents that prolong QT Rapid infusion of agents known to cause Higher doses of predisposing drug raise risk III. Causes

2015 FP Notebook

9. Fridericia formula for QT interval correction

in the past due to QT prolongation and life threatening cardiac arrhythmias. QT interval varies with heart rate, shortening with increase in heart rate. Hence it is usual practice to correct the QT interval for a heart rate of 60 per minute. Fridericia formula for QT interval correction was one of the earliest to be described [1]. The most commonly used is the Bazett formula while the others are Fridericia, Hodges, and Framingham formulas. While Bazett and Fridericia are logarithmic corrections, Hodges (...) Fridericia formula for QT interval correction Fridericia formula for QT interval correction – All About Cardiovascular System and Disorders Now Trending: | October 24, 2017 | | Fridericia formula for QT interval correction Measurement of QT interval is very important because of the potential for life threatening torsade de pointes in the presence of QT interval prolongation. QT interval measurement is very important in the evaluation of any new drug because several drugs have been withdrawn

2017 Cardiophile MD blog

10. Percentile categorization of QT interval as an approach for identifying adult patients at risk for cardiovascular death. (PubMed)

better than the Bazett equation. Using QT-interval percentiles based on heart rate provides a consistent approach both for identifying those whose QT intervals prolong due to drugs or other stressors and for assessing CVD risk.Published by Elsevier Inc. (...) Percentile categorization of QT interval as an approach for identifying adult patients at risk for cardiovascular death. The results from studies of the association of QT prolongation with cardiovascular death (CVD) have been inconsistent.The purpose of this study was to compare the major correction formulas to percentile values of QT for heart rate ranges as to their ability to remove the relationship of QT to heart rate and to predict CVD.Participants were 16,531 veterans who had an initial

2017 Heart Rhythm

11. Long QT syndrome

. Sufferers are at increased risk of syncope, ventricular arrhythmias (including torsades de pointes), and sudden cardiac death. Primary treatment involves beta-blockers and, in selected cases, implantation of a cardioverter-defibrillator, as well as avoidance of competitive sports and QT-prolonging drugs. Definition Long QT syndrome (LQTS) is a genetic or acquired condition characterised by a prolonged QT interval on the surface ECG and is associated with a high risk of sudden cardiac death due (...) Long QT syndrome Long QT syndrome - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Long QT syndrome Last reviewed: February 2019 Last updated: January 2018 Summary An inherited condition involving mutations that affect ion channels important in myocardial repolarisation. May also be acquired secondary to drugs, electrolyte imbalances, or bradyarrhythmias. Twelve-lead ECG commonly shows a prolonged QT interval

2018 BMJ Best Practice

12. QT Correction Formulas Compared to The Rule of Thumb ("Half the QT")

interval is 1000 ms (1 second). 2) At heart rates above 66 beats a minute , the rule of thumb is conservative; it overestimates the QT. In other words, if the QT is less than 1/2 the RR (QT non -prolonged) and the heart rate is above about 60 beats a minute, you can confidently say the QT is not prolonged. 3) At heart rates below 60, far more caution is due. The rule of thumb is less accurate, and the risk is higher because a long QT in the presence of bradycardia ("pause dependent" Torsades (...) to be prolonged if the QT extends more than half the RR interval. We compare this method with the four most common QT correction formulas. This is a detailed post, with interesting graphics produced and conceived by Ph.D., now an EM resident at Beth Israel. The article is written by Dr. Smith and Dr. Friedman. Daniel Lee (HCMC 1st year resident) also did a bit of valuable editing. Figures were produced by Dr. Friedman. Brief Summary of this post: The QTc rule of thumb is this: If the QT interval is less than

2017 Dr Smith's ECG Blog

13. QT Interval

Avoid s, due to risk, precipitating (3.6 fold increased risk) Not all Prolonged QT intervals significantly predispose to Degree of QT Prolongation does not correlate with risk of Medication specific effects (e.g. some medications are more likely to result in ) See for likelihood of Avoid combining multiple medications each of which increase QT Interval Coexisting conditions which make more likely Baseline QT Prolongation Acute Low Ejection Fraction Volume depletion ( , s) Female gender (long QT (...) abnormalities) Type I drugs IV. Complications: QT Prolongation resulting in Torsades de Pointes See for management QT Prolongation risks R-On-T Phenomenon (PVC on ) provoking polymorphic VT ( ) Consider baseline EKG prior to administering medications that may increase QTc Caution in patients with pre-existing QT Prolongation (QTc >450 ms) when prescribing new medications See Select medications that do not prolong the QT Interval further Stop medication causes of Prolonged QT when QTc rises above 500 ms

2018 FP Notebook

14. A case report of QT prolongation with glycopyrronium bromide in a patient with chronic tamoxifen use (PubMed)

was felt to be due to orthostatic hypotension and the QT prolongation secondary to medications, which were both discontinued during her admission. After 2 days, her QT interval normalized consistent with the half-life of Glycopyrronium bromide (13-57 h) compared to Tamoxifen (8-14 days).Glycopyrronium bromide is guideline recommended as first line therapy for prevention of exacerbation in moderate to severe COPD however safety data had been limited to select populations. This case report highlights (...) preceding the event or after regaining consciousness. In the emergency department, she reported dizziness and was found to be hypotensive. Her symptoms completely resolved with intravenous fluids. Lab work was normal however her electrocardiogram (ECG) demonstrated a QTc interval of 603 and 631 ms (Friderica and Bazett's respectively) with a normal QT interval on her baseline ECG prior to initiating Tamoxifen. She was admitted to the Cardiology service for further work-up of QT prolongation. Her syncope

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2016 BMC research notes

15. Citalopram and escitalopram: QT interval prolongation

prolongation has been known for some time and is reflected in the product information. However, recent data have further defined this risk and have clarified that their effects on the QT interval are dose dependent. All available data have been subject to a Europe-wide review. For both citalopram and escitalopram, elderly patients have a higher exposure due to age-related decline in metabolism and elimination. The maximum dose of both medicines has therefore been restricted in patients older than 65 years (...) Citalopram and escitalopram: QT interval prolongation Citalopram and escitalopram: QT interval prolongation - GOV.UK GOV.UK uses cookies to make the site simpler. or Search Citalopram and escitalopram: QT interval prolongation New maximum daily dose restrictions (including in elderly patients), contraindications, and warnings. Published 11 December 2014 From: Therapeutic area: Contents Article date: December 2011 Citalopram, a racemic mixture of R and S citalopram, is a selective serotonin

2011 MHRA Drug Safety Update

16. Race Difference Moxifloxacin-induced QT Prolongation Between Healthy Chinese and Caucasian Volunteers

Race Difference Moxifloxacin-induced QT Prolongation Between Healthy Chinese and Caucasian Volunteers Race Difference Moxifloxacin-induced QT Prolongation Between Healthy Chinese and Caucasian Volunteers - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please (...) remove one or more studies before adding more. Race Difference Moxifloxacin-induced QT Prolongation Between Healthy Chinese and Caucasian Volunteers The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT02119091 Recruitment Status : Unknown Verified April 2014 by Haiyan Li, Peking University Third Hospital

2014 Clinical Trials

17. Long QT Syndrome and Sleep Apnea

Party): Reena Mehra, MD, The Cleveland Clinic Study Details Study Description Go to Brief Summary: Obstructive sleep apnea (OSA) has been associated with cardiac repolarization abnormalities and implicated in sudden cardiac death. A biologically plausible mechanism by which OSA exerts this lethality is by QT interval prolongation, a known marker of ventricular tachyarrhythmias (VTA) leading to cardiac death. Congenital long QT syndrome (LQTS) is a familial arrhythmogenic disorder characterized (...) by prolonged QT interval on the electrocardiogram and increased propensity for VTA. Preliminary data identify an association of the extent of severity of OSA and progressive prolongation of the corrected QT interval in LQTS. Condition or disease Intervention/treatment Phase Long QT Syndrome Sleep Apnea Device: Continuous Positive Airway Pressure (CPAP) Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 50 participants

2018 Clinical Trials

18. Effects of Neostigmine and Sugammadex for Reversal of Neuromuscular Blockade on QT Dispersion Under Propofol Anesthesia: A Randomized Controlled Trial. (PubMed)

Effects of Neostigmine and Sugammadex for Reversal of Neuromuscular Blockade on QT Dispersion Under Propofol Anesthesia: A Randomized Controlled Trial. Reversal of non-depolarizing neuromuscular blocking agent neostigmine is associated with QT prolongation under general anesthesia. To clarify the effects of neostigmine and sugammadex on hemodynamic status, the QT interval and QT dispersion after reversal of neuromuscular blockade were evaluated with a 12-lead electrocardiogram. To exclude QT (...) prolongation due to sevoflurane, the present study was performed under propofol anesthesia.After receiving approval from the ethics committee of Dokkyo Medical University Hospital, 40 patients with American Society of Anesthesiologists physical status I or II were randomly allocated to group N (n = 20) or group S (n = 20). Group N was administered neostigmine (40 μg/kg) and atropine (20 μg/kg), while Group S was administered sugammadex (4 mg/kg) for reversal of neuromuscular blockade after surgery

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2018 Cardiology and therapy

19. The ECG: QT Interval Abnormalities and Sudden Death in Dialysis Patients

is the better studied. The QT interval is a measure of the duration of ventricular de- and re-polarization . Early after-depolarizations, which develop because of a failure of normal repolarization in diseased myocardium or due to certain drugs, result in delayed repolarization and QT interval lengthening. This is an ideal substrate for the development ectopic circuits and arrythymia. Prolonged QT is a well-established risk factor for torsade de pointes, ventricular fibrillation and sudden cardiac death (...) -prolonging medications and dual therapy with two or more QT-prolonging drugs. In fact, 0.5% were taking 5 concomitant QT prolonging agents! The paper included 50 medications that prolong the QT interval and 26 that inhibit their hepatic or renal clearance. The commonest culprits are antibiotics (clarithromycin, erythromycin, levofloxacin) and anti-depressants (fluoxetine, amitriptyline, sertraline, venlafaxine). QT interval dispersion (QTd) is less well recognized and often overlooked. QTd, the longest

2011 Renal Fellow Network

20. Attention deficit hyperactivity disorder in children and young people: guanfacine prolonged-release

) and in children aged 6–12 years (p<0.001; n=333). Safety Safety Guanfacine can cause syncope, hypotension, bradycardia, somnolence, sedation weight gain and QT-interval prolongation. Dose titration and monitoring is required at the start of treatment (Summary of Product Characteristics [SPC] for guanfacine prolonged-release). Blood pressure and pulse may increase following discontinuation of guanfacine. Monitoring and tapering of the dose during withdrawal is recommended (SPC for guanfacine prolonged-release (...) %), fatigue (18.1%), upper abdominal pain (12.0%) and sedation (10.2%). Serious adverse reactions include hypotension (3.2%), weight increase (2.9%), bradycardia (1.5%) and syncope (0.7%). The SPC notes that somnolence and sedation occur predominantly at the start of treatment and may typically last for 2–3 weeks and longer in some cases. Car Cardiac effects diac effects Cardiovascular effects of guanfacine reported in the EPAR are lowering of blood pressure and pulse, and prolongation of QT-intervals

2016 National Institute for Health and Clinical Excellence - Advice

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