Corrected QT-interval prolongation and variability in intensive care patients
Evelien Hoogstraaten1, Saskia Rijkenberg1, Peter H J van der Voort1
1Dept of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
Journal of Critical Care
|July 3, 2014
Summary
Critically ill patients frequently experience corrected QT (QTc) prolongation during intensive care. This study found 52% had prolonged QTc intervals, with significant variability and higher illness severity in these cases.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Electrocardiography
Background:
- Critically ill patients face risks of corrected QT (QTc) interval prolongation.
- QTc prolongation is likely dynamic, but its prevalence and variability in intensive care units (ICUs) are not well understood.
Purpose of the Study:
- To determine the prevalence and variability of QTc prolongation in critically ill patients during their ICU stay.
- To investigate factors associated with QTc prolongation, including medication use and illness severity.
Main Methods:
- A prospective cohort study involving continuous 5-minute QTc measurements in 50 consecutive ICU patients.
- Defined prolonged QTc as >500 milliseconds for at least 15 minutes.
- Assessed QTc variation using QT variance and variability index.
Main Results:
- 52% of patients exhibited QTc prolongation.
- Individual QTc prolongation ranged from 0.2% to 91.3% of the monitoring period.
- Erythromycin and amiodarone use, higher Acute Physiology and Chronic Health Evaluation IV and Sequential Organ Failure Assessment scores, and increased QT/QTc variance were associated with prolonged QTc.
Conclusions:
- Continuous QTc monitoring reveals significant QTc prolongation in over half of ICU patients.
- Higher illness severity and greater QT/QTc variance characterize patients with QTc prolongation.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
522
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
522
01:25Dysrhythmias VII: Nursing Management of Dysrhythmias
508
Nursing management of dysrhythmias involves the following:AssessmentSubjective Assessment:The initial step involves gathering patient-reported symptoms such as dizziness, palpitations, and chest discomfort. It is crucial to collect a detailed history, including previous heart conditions, current medication use, and lifestyle factors like caffeine and alcohol consumption.Objective Assessment:This involves observing clinical signs such as jugular venous distention, cool and pale skin, and...
508
01:26Cardiac Catheterization IV: Nursing Management
1.2K
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
1.2K
01:26Acute Coronary Syndrome V: Nursing Management
611
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
611
01:30Pulse rhythm
1.7K
Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
1.7K
01:30Acute Coronary Syndrome III: Diagnostic Studies
493
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
493