C-L Case Conference: Torsades de Pointes in a Patient With Lifelong Medical Trauma, COVID-19, Remdesivir, Citalopram, Quetiapine, and Hemodialysis.

Autor: Landerholm A; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Department of Psychosocial Oncology, Dana Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: angela_landerholm@dfci.harvard.edu., Fedotova NO; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA., Levy-Carrick NC; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA., Chung R; Department of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Section, Cleveland Clinic, Cleveland, OH., Funk MC; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Jazyk: angličtina
Zdroj: Journal of the Academy of Consultation-Liaison Psychiatry [J Acad Consult Liaison Psychiatry] 2023 Mar-Apr; Vol. 64 (2), pp. 147-157. Date of Electronic Publication: 2022 Nov 06.
DOI: 10.1016/j.jaclp.2022.11.001
Abstrakt: We present a case of Torsades de Pointes (TdP) in a patient with COVID-19 infection and multiple TdP risk factors including QT-interval prolongation, hemodialysis, bradycardia, and treatment with remdesivir, citalopram, and quetiapine. The case was complicated by post-resuscitation anxiety superimposed on a history of medical trauma since childhood. Top experts in the field of consultation-liaison psychiatry, trauma informed care, and cardiac electrophysiology provide perspectives on this case with a review of the literature. Key teaching topics include identification of TdP risk factors in patients with a complex illness; the necessity for prompt electrophysiology consultation in clinical scenarios with high risk for TdP; and the approach to patients with medical trauma using a trauma-informed lens. We highlight the contributions of COVID-19, the pharmacokinetics of QT-interval-prolonging psychotropic medications, the risks of hemodialysis, and the role of remdesivir-induced bradycardia in this first reported case of TdP in a patient treated with remdesivir.
(Copyright © 2022 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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