Page 664 - Cardiac Nursing

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640 PA R T I V / Pathophysiology and Management of Heart Disease
SCD without Structural Heart Disease Drugs that Potentially Prolong the QT
DISPLAY 27-2
A reported 5% to 10% of those patients who experience SCD Interval (Generic Name/Brand Name)
have no apparent structural heart disease. 2,20 There are many po- Antiarrhythmic Agents
tential causes (Display 27-1) of SCD in this small percentage of
patients. The most common of these electrophysiological abnor- Class I
malities are long QT syndrome (LQTS), short QT syndrome Disopyramide/Norpace
(SQTS), Brugada syndrome, and catecholaminergic polymorphic Flecainide/Tambocor
Moricizine/Ethmozine
VT (CPVT). LQTS is either congenital or acquired by use of Procainamide/Pronestyl
drugs, such as antiarrhythmic and psychotropic drugs, or with Propafenonel/Rhythmol
electrolyte imbalances. See Display 27-2 for a list of the most Quinidine/Quinidex
common drugs responsible for acquired LQTS. The list of drugs Tocainide/Tonocard
that are generally accepted to have an increase risk of torsades de Class III
pointes is ever expanding, and can be found at online sites such as Amiodarone/Cordarone
www.qtdrugs.org. Torsades is a type of polymorphic VT, which Ibutilide/Corvert
leads to syncope or SCD. SQTS is relatively newly defined syn- Sotalol/Betapace
drome, with short refractory periods both in the atria and the ven- Dofetilide/Tikosyn
tricles. Brugada syndrome is a genetic disease characterized by a Class IV
right ventricular conduction delay. CPVT is characterized by
Bepridil/Vascor
Antihistamines
Terfenadine/Seldane (Off U.S. Market)
DISPLAY 27-1 Causes of Sudden Death Astemizole/Histamil (Off U.S. Market)
Antimicrobials
Cardiac Causes
Ampicillin/Polycillin
Acute myocarditis Clarithromycin/Biaxin
Aortic or ventricular aneurysm with dissection or rupture Erythromycin/E-mycin
Aortic stenosis Pentamidine/Pentam
Cardiomyopathies Trimethoprim-sulfamethoxazole/Bactrim
Ischemic cardiomyopathy
Nonischemic dilated cardiomyopathy Antidepressants
Hypertrophic cardiomyopathy
Alcoholic cardiomyopathy Amitriptyline/Elavil
Chagas disease Amoxapine/Asendin
Congenital heart disease Clomipramine/Anafranil
Coronary artery abnormalities Desipramine/Norpramin
Myocardial infarction Imipramine/Tofranil
Coronary artery spasm Maprotiline/Ludiomil
Coronary artery embolism Nortriptyline/Pamelor
Endocarditis Protriptyline/Vivactil
Electrophysiologic abnormalities
Brugada syndrome Antipsychotics
Complete AV block Chlorpromazine/Thorazine
Wolff–Parkinson–White Perphenazine/Trilafon
Long QT syndrome—congenital and acquired Risperidone/Risperdal
Catecholaminergic polymorphic ventricular tachycardia Thioridazine/Mellaril
Prolapsed mitral valve syndrome Thiothixene/Navane
Prosthetic aortic or mitral valves Trifluoperazine/Stelazine
Right ventricular dysplasia
Sarcoidosis Antiemetics
Noncardiac Causes Droperidol/Inapsine
Prochlorperazine/Compazine
Cerebral or subarachnoid hemorrhage
Choking Gastrointestinal Agents
Dissecting aneurysm of the aorta
Electrolyte abnormalities Cisapride/Propulsid
Metabolic disturbances Ipecac syrup
Pulmonary hypertension (primary, particularly during
pregnancy) Lipid-Lowering Agents
Pulmonary embolism Probucol/Lorelco
Sudden infant death syndrome (should at least in part be
included in cardiac causes)
Adapted from 2005 American Heart Association Guidelines for CPR and ECG.