Be wary, these commonly used medicines may also lead to children's arrhythmia

For medical professionals for reading reference

Be cautious with medication!

The 27 -year -old female host of Hefei, Anhui Province, suffered from mycoplasma pneumonia. During her hospitalization at the First Affiliated Hospital of Anhui Medical University, she died unfortunately. According to the cause of the death report provided by the family, the cause of the use of drug abnormality caused by the use of drugs in the use of drugs (Figure 1).

Figure 1: originated from the Internet

Here we do not discuss the right and wrong of the patient and the hospital. The question we pay attention to is: Why can Mossica stars lead to sudden death? As a pediatrician, in clinical work, what other drugs can cause similar serious arrhythmia?

First of all, we know that the application of Moshaxing in clinical clinical can cause a child with a severe arrhythmia -the QT interval extended syndrome, further developing into a cutting -edge tachycardia at the cutting -edge of the tip Stop or sudden death.

What is the QT interval syndrome?

QT interval extension syndrome or long QT syndrome (LQTS), also known as compound delay syndrome, is a set of ventricular compound pole extension (QT interval extension, as shown in Figure 2). It is very easy to occur with cutting -edge tires (as shown in Figure 3), ventricular fibrillation, and sudden heartogenic death syndrome, and some of them have genetic tendencies [1]. There are congenital and acquisition. At present, it is believed that this syndrome is not only hereditary, but the chronic infection of the virus or a certain non -infectious degeneration may also lead to the occurrence of this syndrome.

Figure 2: LQTS: QT interior period is significantly extended (R-R = 1.00 seconds, QT interval = 0.56 seconds, QT interval corrected heart rate [qtc] = 0.56 seconds). Almost every leader can observe the abnormal form of the compound pole (that is, the peak T wave, the bow -shaped ST section).

Figure 3: Speed ​​tachycardia at the tip torture: Three leaders can see the up and down and down of the QRS electrical shaft, and the width QRS wave group tachycardia [2]

Congenital LQTS (CLQTS) is caused by mutation of the genes of cardiac, sodium, or calcium ions, and has a genetic chain relationship with chromosomal No. 3, 4, 7, 11, and at least 10 genes have been identified. Schwartz et al. [3] in 1993 proposed CLQTS diagnostic standards (Table 1), which is still the best standard for clinicians.

Table 1: diagnostic standard for CLQTS

Note: ☆ Specifies of the speed and syncope of cutting -edge torture; § The second percentage of the calm heart rate is lower than the normal value of the same age; : ≤1 points, except LQTS; 1.5 ~ 3 points, suspicious LQTS; ≥3.5 points, confirmed LQTS.

S There are many reasons for obtaining sex LQTS, and there are several cases of the following situations [4]:

1. Drugs.

2. Cardiomo, historical abnormalities: arrhythmia, coronary heart disease, hypertension, heart failure, cardiomyopathy (hypertrophic myocardial disease, dilated cardiomyopathy, etc.), two -pointed valve prolapse and so on.

3. Electrolytic disorders: hypokalemia, hypodermoremia, hypocalcemia, etc.

4. Neurological diseases: cerebrovascular accidents, encephalitis, trauma brain injury, subjuilder subeoflum hemorrhage, etc.

5. Systemic diseases: diabetes, abnormal sugar tolerance, connective tissue disease, renal failure, alcohol poisoning, organic phosphorus poisoning, neuropathic anorexia, chromium -only cell tumor, AIDS, new coronary virus infection in recent years [5].

6. Genetic susceptibility: related to related gene mutations.

7. Other factors: such as the decrease in acute weight, chronic arsenic poisoning, food (grapefruit juice, green tea), drug abuse, esophagealitis, alcohol abstaining syndrome, neck lymph node cleansing, etc.

SMoving sex LQTS clinical diagnosis:

Clinical history;

Treatment factors: such as drugs, low potassium, low magnesium, etc.;

ECG: QT is extended.

Which drugs can cause LQTS in clinical work?

As a pediatrician, the clinical work is mainly diagnosis and treatment. The use of drugs is one of the most important means for treatment. Which drugs may cause LQTS to be known because it may lead to severe heart events, although this probability is less.

1. Macosacerfs of antibiotics: such as Azithromycin, erythromycin, craticin, and linsecin. Its mechanism: Inhibit the potassium current (IKR) ion channel, extend the time of the action of ventricular muscle cells, which will cause the QT interval to prolong.

For example, a case a few years ago: 12 -year -old boy had a history of heart and illness. Due to Azithromycin, dizziness, vomiting, and palpitations appeared on the fourth day. Rescue is invalid. Fang Xuehua et al. [6] reported that a 36 -year -old woman, which was taken with erythromycin excessive and caused a long QT syndrome, and then turned to cutting -edge torture room speeds, which was rescued in time.

Figure 4: Source Network

2. Antibiotic olsine :loxacin, Polygonal Star, Mossian Scholar, Levofloxacin, etc. Among them, Mossian husaccharine has the most risk of QT's extension, and Sipon Star has the smallest risk of QT extension. The mechanism: By blocking potassium ions in myocardial cells to suppress IKR, and delayed the heart reexamination of the heart and extend the QT interval.

For example, Yu Ting et al. [7] reported that a 68 -year -old male patient, during the process of acute pancreatitis static levofloxacin anti -inflammatory processes, a fainting appeared, the ECG showed the QT interval extended, turned to a cutting -back room speed, and the left oxygen was suspended after rescue. After the QT period gradually recovered. 3. Sulfa of antibiotics: compound sulfa sul-sulpyzole (SMZ-TMP) concentration is very large to inhibit the IKR channel, causing QT to prolong the interior period.

4. Antibiotics of Grancornezazole: metronidazole is a powerful hepathase inhibitor, which can cause the QT interval to prolong.

5. Antibacterial drugs: such as ketonazole, nimatonazole, clonazole, etc. Under certain circumstances, the QT interval will be prolonged, thereby inducing the tip torture room speed.

Its mechanism: Such drugs contain a heterocyclic nitrogen atomic structure. By combining with iron atoms in cytochrome P450, hepatocytoma P450 enzymes are suppressed. When combined with drugs with hepatocytic pigment P450 enzyme metabolism, the drug concentration in the body can be too high, causing the QT interval period.

6. Anti -virus: such as Lopanovir, Naisovir, Litonova, etc. present dose -dependent blocking IKR currents; as well as tadonamine, gasolovir can also cause QT to extend.

7. Antiopiantomy: Such as quinine, Shikui, etc. can cause QT to extend.

8. Gastrointestinal dynamic drug: It can inhibit the IKR channel, cause the action potential time and the QT interval period, and cause severe arrhythmia and sudden death.

9. Anti -rhythm: such as iodone, sootolol, quininine, propyramamine, Protarine, bromine, and so on.

Its mechanism: Amine iodine inhibits potassium ions of myocardial cells, and uses the side effects of the QT interval with hypocritical and other drugs that extend the QT period. Queinine, propyramine, Pulukinhamine and other sodium potassium blockers and potassium channel blocks such as Soblol can extend the QT interval. Liu Na et al. [8] reported that the conventional dose of iodone caused 1 case to extend the QT interior period.

10. Antidamine: such as asimzole, Avastein, deornidin, Tetfinin, Setolizine, etc. The mechanism is also inhibiting the IKR channel, which extend the action potential and extend the QT interval.

11. Anti -psychiatric drugs: For example, chloropeniazine acts on sodium ion channels, fluoropytine alcohols, penoni, etc. to extend the QT interval through blocking IKR channels on myocardial cells.

12, antidepressants: such as amparin, propyrazine, dodapin, clotamipumin, Pharaoh Pamamin, Fluosing, etc.

Amiolin and propyzine block the heart nerve cells intake of norepinephrine, which causes myocardial lack of norepinephrine, leading to extension in the interval; fluoricine blocking sodium ion channels, enhancing short potassium ions outflow, thereby shortening the action to move the action In the potential time, the internal compound polarization and multiple reflection of the ventricular muscle are generated.

13. Other: chemotherapy drugs such as ectopicin, alkylated agent, and anti -alienal drugs can cause heart toxicity, causing QT to extend; cause diuretics of low potassium; a variety of anesthesia, and so on. The Rongli Army et al. [9] reported that the swallowing of sorcer bile causing the QT to extend one case.

ECG QT is prolonged by the electrocardiogram of the drug, and its important risk factors include: women (women are obviously more than men) [10]; electrolyte disorders (hypocity and hyponiasis); low temperature; abnormal thyroid function; structural heart heart; structural heart heart; structural heart heart; structural heart heart; structural heart heart; Disease; Sudden mind and so on.

Drug -induced QT extension may also have a genetic background, including the susceptibility of ionic channels to abnormal dynamics caused by genetic mutations or polymorphisms.

In clinical work, when the girls need to use the above -mentioned drugs that can easily induce cardiac incidents, we need to pay more attention to our medical workers. For normal people, the probability of this heart event is less likely, but who wants to draw this devil. Sign!

For more popular medicines, where can I learn?

You who just joined the subject, do you want to master the common drugs commonly used? What situations need to be adjusted? Do you want to double the first use? Whether the solution is salted or sugar with salt ...

As a veteran of Kuri, what is the difference between injection and tablets? What can I learn from foreign usage? How to calmly cope with excessive drugs? In the face of newcomers in the Division, how can I throw a link elegantly to let Xiaobai learn about medication?

Dried medicine you want

The "Pediatric Medicine Medicine" column of the doctor's station is all

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