Aslam Waqas, Lamb Carla R, Ali Nadia
Pulmonary and Critical Care Medicine, Interventional Pulmonology, University of California San Francisco, Fresno, California, USA
Pulmonary and Critical Care Medicine, Interventional Pulmonology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
BMJ Case Rep. 2021 Mar 24;14(3):e239963. doi: 10.1136/bcr-2020-239963.
Hydroxychloroquine has been widely prescribed to treat patients with COVID-19 pneumonia. A 73-year-0ld woman with COVID-19 pneumonia was treated with dexamethasone and hydroxychloroquine. Her home medications, citalopram and donepezil, were continued. The ECG prior to starting hydroxychloroquine showed normal sinus rhythm with prolonged corrected QT (QTc) of 497 ms, due to citalopram and donepezil therapy. Repeat ECG on days 3 and 4 of hydroxychloroquine therapy showed significantly prolonged QTc of 557 ms and 538 ms, respectively, despite normal serum electrolytes. All QT-prolonging medications including hydroxychloroquine were discontinued on day 4; however, she suffered a transient torsades de pointes lasting for about 15 s, which resolved before any intervention. QTc improved to 477 ms, after discontinuation of QT-prolonging medications. The patient had QTc prolongation and torsades de pointes due to therapy with multiple QT-prolonging medications. Medicine reconciliation and careful monitoring of QTc may help prevent cardiac complications in patients with COVID-19 treated with hydroxychloroquine.
羟氯喹已被广泛用于治疗新冠肺炎患者。一名73岁的新冠肺炎女性患者接受了地塞米松和羟氯喹治疗。她的家庭用药西酞普兰和多奈哌齐继续使用。开始使用羟氯喹之前的心电图显示窦性心律正常，但由于服用西酞普兰和多奈哌齐，校正QT间期（QTc）延长至497毫秒。在羟氯喹治疗的第3天和第4天重复心电图检查显示，尽管血清电解质正常，但QTc分别显著延长至557毫秒和538毫秒。在第4天停用了包括羟氯喹在内的所有可延长QT间期的药物；然而，她出现了持续约15秒的短暂尖端扭转型室速，在任何干预之前自行缓解。停用可延长QT间期的药物后，QTc改善至477毫秒。该患者因使用多种可延长QT间期的药物治疗而出现QTc延长和尖端扭转型室速。药物核对和对QTc的仔细监测可能有助于预防接受羟氯喹治疗的新冠肺炎患者出现心脏并发症。
