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QT interval refers to the distance from the starting point of the QRS wave group to the end point of the T wave, which represents the time required for the ventricular muscle to remove the extreme and compound pole.The greatest harm of QT interval period is that long QT Syndrome (LQTS) can lead to long QT syndrome, that is, due to the extension of the QT interval and abnormal T wave, it can easily lead to malignant ventricular arrhythmia (especially the cutting -end chamber of the polyphonic chamber.A group of syndrome of speed, ventricular fibrillation, etc.), syncope and sudden death [1].
LQTS can be divided into congenital and acquisition, and obtaining LQTS can be metabolic abnormalities (such as acute hypokalemia, etc.), diseases (such as myocarditis, subjuble inferior cavity hemorrhage, etc.) And various drugs that cause QT extension to cause [2].
These three commonly used medicines can cause QT intervals to be extended!
▌ iodine
Antone iodine can cause QT interval to extend. The effect and dose of the extension of the QT interval period. The larger the dose, the more obvious the extension of the QT interval period.The incidence of incidents caused by iodone to cause arrhythmia is 2%, which causes the QT to be evenly extended evenly, and it is not easy to form a return. The amino iodine itself has a certain β receptor block and calcium channel blocking effect, which can reduce it by it.The early removal is caused, so although amino iodine can cause significant QT intervals, the incidence of TDP is not so high [3-5].
▌ Danpanlidone
The risk of the QT interval extension and the risk of ventricular heartbeat (TDP), especially in combination with other extension of the QT interval period, or merged with low potassium and applied with CYP3A4 inhibitors (erythromycin, claxycin, ascin, ketone, ketoneIn other risk factors such as crickets and inxazole), the risk of TDP will be further increased [3-4].
▌ Antibacterial drug35Q2UA7U "> Macrides, antibacterial drugs such as erythromycin and craticin have clearly reported that the QT inter -inter -periodic period is extended, resulting in tdp and sudden cardiac death.Its rhythm is considered to be blocked by potassium channels, resulting in extension of the QT interval.At the same time, large-cycle endone antibacterial drugs are metabolized through CYP3A4, such as combined with CYP3A4 inhibitors, which will cause QT to extend more significantly, and the risk of TDP will be further increased [3-4,6].
Case challenge!
Patients, male, 75 years old, admitted to the hospital for "fever, cough, sputum for more than 10 days".
Past history: there is coronary atherosclerotic heart disease, long -term oral aspirin enteric soluble tablets 100mg QD, Atorvastatin calcium tablet 10mg qn, liquor sketching 25mg bid 25mg BIDEssence
Checking: 36.8 ° C in body temperature, 86 times/min pulse, 18 times/min, blood pressure 98/60mmHg.God is clear, weak, lips are gently purple, bilateral breathing sounds, smelling and wet elastic, heart rate 86 times/min, heart rhythm, no smell and noise.
Diagnosis of admission: bacterial pneumonia.
Diverse: On the 3rd day of admission, add 10 mg TID of Doraone tablets to promote gastrointestinal power and avoid reflux and misuse.On the 4th day of urine culture, it is prompted to be Candida, and the infection is given to control the infection in the injection of voltoleum 0.2g Q12H, and then the heart rate is 123 times/min, not hearing and murmur.shrink.
Question: What do you think of the patients arrhythmia?Poke me to see the answer
Drug QT extension is extended. How to prevent it?
Proficient in clinical common clinical may leadDrugs, pay attention to the correct usage and dosage, and use as much as possible to use and use long -term use on the basis of ensuring the efficacy.
Try to avoid the use of drugs that may cause extension of QT interval, or it may affect such drugsOther drugs of metabolism.
When the patient has a non -drug non -drug factor extended in QT (such as the elderly, the heart is moving,Subsidy, congenital LQTS, electrolyte disorders, diabetes, hypertension, cerebrovascular disease, coronary heart disease, heart failure, thyroid dysfunction, etc.), avoid use or use drugs that may cause extension of QT intervals under close observation.
QT inter -inter -inter -inter -period extension and TDP caused by the occurrence of drugs, first of all, any known that may extend the QT inter -period periodDrugs, correcting electrolyte disorders and increasing heart rate.Those who extend the lighter period of the QT interval, and generally gradually return to normal QT after the drug discontinued; the extension of the QT interval is progressing to TDP, and the ECG monitoring should be performed immediately.Temporary or permanent pacemakers are implanted. The goal is to increase the heart rate, shorten the QT interval, prevent abnormal compound polarization or early depression, and prevent sudden heart death [3-4,7].
For more medication information, click the applet to check quickly
Ibuprofenycinicoinosaccharotic acid asceololfiroolfamine isocelacinoside fluororitizine, oligrapholine levicone, sodium sodium glucose glycotate, glycoglin calcium, Perbarin leuotanal gonadinine sodium nitrate monomeryosolic acid strainMonacriferite non -Tissamine polypropyrazide benzide phenylphenol phosphate ovidyl tinidohrodidoliwenzolonolon litamin ketonettetinolinobolinLuste sodium
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References:
[1] Zheng Meixia.Causes and clinical treatment of tachycardia [J]. Chinese drugs and clinical, 2018, 18 (11): 1936-1937.
[2] Heyang.QTs potential danger [J]. Traditional Chinese and Western medicine combined cardiovascular disease electronics magazines, 2018, 6 (8): 178-179.
[3] Huang Zhenhua. Drug induction induced.QT interval extension and cutting-edge-to-end-to-be-tentative ventricular tachycardia research progress [J]. China New Pharmaceutical and Clinical Magazine, 2016, 35 (7): 473-477.
[4] Lu Yan, Wang Lin, Yang Yanru, waiting for. 129 cases of pharmaceuticals Q-T extended the end of the tap of tachycardia at the end-of-tip tortuous chamber. [J]. Tianjin Pharmacy, 2021, 33 (2): 22-27.
[5] Du Yipeng, Ouyang Hong, Bu Tong, et al. Short -term oral amine iodone iodone iodone to tip tortoise tachycardia 1 case [J]. ECG and cycle, ECG and cycle,2021, 40 (1): 88-90.
[6] The research progress of the heart safety of Zhang Yanting, Chen Yuan, Zhao Wei., 2018, 25 (2): 166-170.
[7] Ding Guanhuang, Zhang Xinli, Wang Qiong, etc.Revelation [J]. China Drug Alert, 2018, 15 (9): 545-549.
