ECG Changes Associated With Antipsychotic Use: A Case Vignette From the Emergency Department

Patients with psychiatric disorders presenting to the Emergency Department (ED) are at increased risk for cardiac complications when treated with antipsychotic medications. Many antipsychotics are associated with unpredictable effects on cardiac conduction, particularly QTc prolongation, which may lead to life-threatening arrhythmias such as Torsades de Pointes and ventricular tachycardia. These risks are heightened in agitated patients who require high doses of antipsychotics. Selecting an appropriate agent demands a careful balance between psychiatric stabilization and cardiovascular safety. First- and second-generation antipsychotics, including the commonly used haloperidol and ziprasidone, are known to cause QTc prolongation, the most clinically significant ECG abnormality. Effective management requires individualized assessment, vigilant ECG and electrolyte monitoring, and informed antipsychotic selection. This case study highlights the clinical presentation and potential ECG changes associated with antipsychotic medication use in the ED.