Patel Prutha V, Desai Yash K, Khan Minaal, Naseer Zaid A, Marney Michael, Exeer Ahmed M, Osmani Gul P, Sulliman Mahmood, Manalai Partam
Internal Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA.
Psychiatry and Behavioral Sciences, Liberty University College of Osteopathic Medicine, Lynchburg, USA.
Cureus. 2025 Aug 13;17(8):e90033. doi: 10.7759/cureus.90033. eCollection 2025 Aug.
Severe chronotropic insufficiency, while uncommon in psychiatric populations, presents unique challenges in patients with psychotic disorders because many antipsychotics can adversely affect cardiac rhythm by exacerbating bradycardia or prolonging the QT interval. This case report describes a young male with a complex psychiatric history, severe substance use disorder, and coexisting cardiac abnormalities, who presented with profound sinus bradycardia and a prolonged QT interval. The patient's psychiatric symptoms were compounded by medication nonadherence and illicit drug use. The patient had a history of profound sinus bradycardia (heart rates in the 20s to 30s) with a mean heart rate of 41 beats/min (SD = 4), yet remained asymptomatic from a cardiovascular perspective. Despite the presence of bradycardia and a prolonged QT interval (mean QT = 495 ms (66), QTcB = 427 (30) (Bazett), and QTcF = 448 (32) (Fridericia)), he was treated with oral olanzapine and valproate. His psychiatric symptoms improved significantly, with no exacerbation of bradycardia or QTc prolongation noted during treatment. This is a rare case of a hemodynamically stable young man treated with second-generation antipsychotics, without any notable effect on the length of the QT interval. QT prolongation is a side effect of many antipsychotics, and bradycardia tends to further prolong the QT interval, increasing the risk of adverse cardiac outcomes, such as torsades de pointes or sudden cardiac death, for patients taking antipsychotics. An interprofessional, interdisciplinary, and cohesive team can reduce the cardiac risk to the patient while effectively treating the underlying psychiatric disorders. Nonetheless, it is essential for psychiatrists to have a solid understanding of psychotropic medications and cardiac rhythms, particularly because many free-standing psychiatric facilities do not have direct access to a cardiology consult team. In this report, the authors will attempt to provide a structured framework for psychiatrists managing patients with bradycardia who require antipsychotic therapy.
严重变时性功能不全在精神科人群中并不常见，但在患有精神疾病的患者中会带来独特的挑战，因为许多抗精神病药物会通过加重心动过缓或延长QT间期而对心律产生不利影响。本病例报告描述了一名年轻男性，他有复杂的精神病史、严重的物质使用障碍和并存的心脏异常，出现了严重的窦性心动过缓和QT间期延长。患者的精神症状因不依从药物治疗和使用非法药物而加重。该患者有严重窦性心动过缓病史（心率在20到30次/分钟），平均心率为41次/分钟（标准差=4），但从心血管角度来看仍无症状。尽管存在心动过缓和QT间期延长（平均QT = 495毫秒（66），QTcB = 427（30）（Bazett法）以及QTcF = 448（32）（Fridericia法）），但他仍接受了口服奥氮平和丙戊酸盐治疗。他的精神症状有显著改善，治疗期间未发现心动过缓或QTc延长加重。这是一例用第二代抗精神病药物治疗的血流动力学稳定年轻男性的罕见病例，对QT间期长度没有任何显著影响。QT间期延长是许多抗精神病药物的副作用，心动过缓往往会进一步延长QT间期，增加服用抗精神病药物患者发生不良心脏事件的风险，如尖端扭转型室速或心源性猝死。一个跨专业、跨学科且有凝聚力的团队可以在有效治疗潜在精神疾病的同时降低患者的心脏风险。尽管如此，精神科医生必须扎实了解精神药物和心律，特别是因为许多独立的精神科机构无法直接获得心脏病学咨询团队的服务。在本报告中，作者将试图为管理需要抗精神病治疗的心动过缓患者的精神科医生提供一个结构化框架。
