Torsades De Pointes

Over the past 25-30 years, deaths due to Torsades de Pointes (TdP) have resulted in numerous drugs being withdrawn from the market. However, nearly 200 drugs that may prolong the QT interval and cause TdP remain available. A number of drugs with the potential to cause TdP are among the top 200 most prescribed drugs in the US, whilst new information regarding TdP is emerging rapidly. The purpose of this book is to provide a comprehensive source of information on the topic of torsades de pointes (TdP), which is a life-threatening polymorphic ventricular tachyarrhythmia associated with QT interval prolongation on the electrocardiogram (ECG). Torsades de Pointes provides a detailed, up-to-date and emerging information related to the epidemiology, drug culprits, mechanisms, risk factors, and methods of prevention and management of the life-threatening polymorphic ventricular tachycardia, also known as torsades de pointes. The book contains current knowledge, incorporating recent and cutting-edge advances in understanding of topics including inherited channelopathies and congenital LQTS; drugs that cause QT interval prolongation and TdP; non-drug causes of acquired QT interval prolongation and TdP; epidemiology of inherited and acquired TdP; morbidity and mortality associated with TdP, particularly in association with specific antimicrobials, antidepressants and antipsychotics, and methadone; cellular and molecular mechanisms of TdP, traditional and emerging risk factors for TdP; methods of prevention and risk reduction for TdP; and clinical management of patients with TdP. This book is an essential reference for both clinicians and researchers – providing guidance for clinicians who care for patients receiving QT interval-prolonging drugs, as well as cutting edge information for scientists and investigators conducting research in the area. Up-to-date information on TdP associated with inherited channelopathies and the multiple forms of congenital LQTS Includes a wealth of new information emerging regarding TdP, including newly-described risk factors and cellular and molecular mechanisms, contributions of genetic polymorphisms to drug-induced TdP, methods of quantification of risk, and methods of risk reduction, including clinical decision support Contains information on nearly 200 commonly used drugs that have the potential to cause torsades de pointes, including antimicrobials, antipsychotics, antidepressants, antiarrhythmic agents, methadone, and many others An essential reference for clinicians and researchers – provides guidance for clinicians who care for patients receiving QT interval-prolonging drugs, as well as cutting edge information for scientists and investigators conducting research in the area

In recent years there has been considerable interest in the diagnosis and understanding of ventricular repolarisation, particularly the QT interval prolongation and abnormal T and T/U wave morphology associated with torsades de pointes. Advances in ion channel cloning have greatly improved our understanding of the role of ionic channels in mediating cardiac repolarisation. Unfortunately, it is increasingly recognised that a number of drugs, both those associated with altering repolarisation, and others for non-cardiac conditions can increase the propensity for polymorphic ventricular tachycardia, syncope and even ventricular fibrillation and sudden death. In this volume, arrhythmia specialists from St. George’s Hospital Medical School, London discuss the mechanisms behind QT prolongation and torsades de pointes. They focus particularly on the risk of individual cardiac and non-cardiac drugs in provoking long QT syndrome, providing a comprehensive review which will be useful for all electrophysiologists treating polymorphic ventricular tachycardias, and will expose important regulatory issues for pharmaceutical authorities and for the wider medical community.

One of the most time-consuming tasks in clinical medicine is seeking the opinions of specialist colleagues. There is a pressure not only to make referrals appropriate but also to summarize the case in the language of the specialist. This book explains basic physiologic and pathophysiologic mechanisms of cardiovascular disease in a straightforward manner, gives guidelines as to when referral is appropriate, and, uniquely, explains what the specialist is likely to do. It is ideal for any hospital doctor, generalist, or even senior medical student who may need a cardiology opinion, or for that ma.

To most cardiologists, the long QT syndrome is a relatively rare congenital and familial syndrome that affects children or young adults. However, in addition to congenital LQTS there is a series of acquired forms of the syndrome, usually resulting from exposure to drugs that extend the duration the QT interval. This prolongation may be the primary pharmacodynamic action of the drug, however a plethora of other drugs, including some types of antibiotic, antipsychotics, antidepressants, antimalarials and antihistamines may provoke QT interval prolongation. The aim of the Clinical Approaches to Tachyarryhthmias series is to update the physician, cardiologist, and all those responsible for the the care of patients with cardiac arrhythmias. In this volume, Dr. Yap and Dr. Camm expose the data implicating a large number of drugs as potential QT prolongators.

Part of the highly regarded Braunwald’s family of cardiology references, Clinical Arrhythmology and Electrophysiology, 3rd Edition, offers complete coverage of the latest diagnosis and management options for patients with arrhythmias. Expanded clinical content and clear illustrations keep you fully abreast of current technologies, new syndromes and diagnostic procedures, new information on molecular genetics, advances in ablation, and much more.

Until recently, the cellular basis for sudden death, the BrugadaSyndrome, has largely remained an unknown to modernarrhythmologists and cardiologists, particularly in the absence ofany structural heart disease. Detailed observations of age-groups,especially the young, families and populations where sudden deathfrequently occurs, and improved understanding of its contributoryfactors and mechanisms are, however, showing the way forward. This addition to the Clinical Approaches to Tachyarrhythmias(CATA) Series, written by the investigators who discovered andprobed the Brugada Syndrome, discusses the history, etiology,pathology and clinical manifestations of sudden death. Fromdiagnosis, prognosis, to therapeutic approaches using the latest incathater ablation techniques, electrophysiological surgery, andgenetic appraisal, the work is a testimony to the author'sinvestigation. Using clinical cases in Thailand and Laos, theyfurther unravel the syndrome's molecular mechanisms, studyingrelated syndromes, such as the long-QT syndrome, infant death, andarryhthmogenic right ventricular cardiomyopathy. By being informed of the electrophysiological abnormalities thatcontribute to familial and genetic diseases, physicians,cardiologists and all those who care for patients with cardiacarrhythmias will be better able to identify and treat patients inwhom the Brugada Syndrome may strike next.

Ventricular arrhythmias cause most cases of sudden cardiac death, which is the leading cause of death in the US. This issue reviews the causes of arrhythmias and the promising new drugs and devices to treat arrhythmias.

This comprehensive book provides reviews of pain management complications that arise in clinical practice. Organized into sections focused on types of pain therapy and procedures, each chapter is based on actual complications; starting with a case description that delineates the context with a short past medical and surgical history, pain management technique and outcome it is followed by a comprehensive review of the topic described in the first section. Authors emphasize the elements of differential diagnosis that pointed towards establishing of the complication and describe the best way to treat the identified complication. Physicians treating pain patients will be presented the necessary tools in identifying and treating unanticipated complications following pain interventions, thus providing safer care for their patients.