warfarin and Long-QT-Syndrome

The older adult population is increasing and with it, the risk of polypharmacy. Multiple physicians treating one patient, increasing comorbidities, and an increase in the variety of drugs available contribute to the adverse effects of polypharmacy on the elderly patient. Application of Beers criteria, appropriate therapeutic drug monitoring, and careful, periodic review of the patient's medication list will assist with preventing the sometimes lethal complications of polypharmacy.

Topics: Aged; Anticoagulants; Cholinergic Antagonists; Drug Interactions; Drug Monitoring; Humans; Hypnotics and Sedatives; Long QT Syndrome; Polypharmacy; Warfarin

Topics: Amiodarone; Anti-Arrhythmia Agents; Anticoagulants; Brugada Syndrome; Drug Interactions; Fibrinolytic Agents; Hemorrhage; Heparin; Humans; Long QT Syndrome; Lung Diseases, Interstitial; Platelet Aggregation Inhibitors; Thrombocytopenia; Vasodilator Agents; Warfarin

Although the maintenance of sinus rhythm would be the ideal scenario for patients with atrial fibrillation (AF), recent randomised trials have questioned the value of this approach. A careful interpretation of their results showed the limited efficacy of currently available antiarrhythmic drugs in maintaining sinus rhythm, as well as their potentially serious side effects. Therefore, it is imperative to develop safer and more effective drugs for AF. Based on our improved understanding of the pathophysiology of AF and the mechanism of action of antiarrhythmic drugs, significant efforts are being made to develop new antiarrhythmic agents that would prevent electrophysiological remodelling, would be selective for the atria and, therefore, would not prolong ventricular repolarisation, thus lacking any proarrhythmic effect.

Topics: Adrenergic beta-Antagonists; Aged; Anti-Arrhythmia Agents; Anticoagulants; Aspirin; Atrial Fibrillation; Calcium Channel Blockers; Electrocardiography; Humans; Long QT Syndrome; Middle Aged; Platelet Aggregation Inhibitors; Potassium Channel Blockers; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Tachycardia, Ventricular; Warfarin

The patient presented with syncope, without chest pain and dyspnea. There was no peripheral edema or nervous system signs. The electrocardiogram (ECG) showed QT-interval prolongation with T-wave inversion in anterior and inferior leads. T-wave inversion in the right-sided precordial leads should prompt consideration of right ventricular overload. The patient underwent computed tomography of the chest that demonstrated pulmonary embolism. Ultrasonography of the veins of the lower limbs revealed an isolated calf vein thrombosis.

Topics: Aged; Anticoagulants; Electrocardiography; Female; Humans; Leg; Long QT Syndrome; Pulmonary Embolism; Syncope; Tomography, X-Ray Computed; Ultrasonography; Venous Thrombosis; Warfarin