Early Morning QT Prolongation During Hypoglycemia: Only a Matter of Glucose?

D'Imperio, Sara; Monasky, Michelle M.; Micaglio, Emanuele; Negro, Gabriele; Pappone, Carlo

doi:10.3389/fcvm.2021.688875

Cited by 8 publications

(7 citation statements)

References 42 publications

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“…There is already a lot of evidence for genetic overlap between BrS and other cardiac pathologies. Overlap between BrS and LQTS type 3 has been described (198), even sharing the same mutation in the SCN5A gene as the likely molecular cause (13,199). In fact, variants in the SCN5A gene have been described as causative for a number of other cardiac pathologies, such as ARVC/D, atrial standstill, atrial fibrillation, left ventricular non-compaction, dilated cardiomyopathy, LQTS, sick sinus syndrome, idiopathic ventricular fibrillation, and heart block (200,201).…”

Section: Genetic Overlapmentioning

confidence: 99%

Brugada Syndrome: Warning of a Systemic Condition?

D'Imperio

Monasky

Micaglio

et al. 2021

Front. Cardiovasc. Med.

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Brugada syndrome (BrS) is a hereditary disorder, characterized by a specific electrocardiogram pattern and highly related to an increased risk of sudden cardiac death. BrS has been associated with other cardiac and non-cardiac pathologies, probably because of protein expression shared by the heart and other tissue types. In fact, the most commonly found mutated gene in BrS, SCN5A, is expressed throughout nearly the entire body. Consistent with this, large meals and alcohol consumption can trigger arrhythmic events in patients with BrS, suggesting a role for organs involved in the digestive and metabolic pathways. Ajmaline, a drug used to diagnose BrS, can have side effects on non-cardiac tissues, such as the liver, further supporting the idea of a role for organs involved in the digestive and metabolic pathways in BrS. The BrS electrocardiogram (ECG) sign has been associated with neural, digestive, and metabolic pathways, and potential biomarkers for BrS have been found in the serum or plasma. Here, we review the known associations between BrS and various organ systems, and demonstrate support for the hypothesis that BrS is not only a cardiac disorder, but rather a systemic one that affects virtually the whole body. Any time that the BrS ECG sign is found, it should be considered not a single disease, but rather the final step in any number of pathways that ultimately threaten the patient's life. A multi-omics approach would be appropriate to study this syndrome, including genetics, epigenomics, transcriptomics, proteomics, metabolomics, lipidomics, and glycomics, resulting eventually in a biomarker for BrS and the ability to diagnose this syndrome using a minimally invasive blood test, avoiding the risk associated with ajmaline testing.

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Section: Genetic Overlapmentioning

confidence: 99%

Brugada Syndrome: Warning of a Systemic Condition?

D'Imperio

Monasky

Micaglio

et al. 2021

Front. Cardiovasc. Med.

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“…The syndrome is clinically characterized by syncope episodes and SCD due to ventricular tachyarrhythmias [ 12 ]. LQTS can be congenital or acquired, therefore, a prolonged QT interval may result from genetic abnormalities, mineral imbalances, or certain medications [ 13 ]. It manifests as ECG abnormalities, including prolonged QT-interval, Torsade de Pointes (TdP), and ventricular fibrillation (VF) [ 14 ].…”

Section: Brugada Syndrome and Long Qt Syndromementioning

confidence: 99%

“…Moreover, epinephrine test is able to unmask the prolongation of the QT intervals in patients with ‘concealed LQTS’ [ 15 ]. The ECG may result normal at rest but based on the subtype, ECG abnormalities can be triggered by physical stress, emotional stress, dietary changes, certain drugs, or during sleep or at rest [ 16 , 17 ], and it has also been associated with metabolic syndromes and eating disorders [ 13 ]. LQTS primarily affects young people and is one of the main causes of SCD in this population [ 18 ].…”

Section: Brugada Syndrome and Long Qt Syndromementioning

confidence: 99%

Impact of Dietary Factors on Brugada Syndrome and Long QT Syndrome

et al. 2021

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A healthy regime is fundamental for the prevention of cardiovascular diseases (CVD). In inherited channelopathies, such as Brugada syndrome (BrS) and Long QT syndrome (LQTS), unfortunately, sudden cardiac death could be the first sign for patients affected by these syndromes. Several known factors are used to stratify the risk of developing cardiac arrhythmias, although none are determinative. The risk factors can be affected by adjusting lifestyle habits, such as a particular diet, impacting the risk of arrhythmogenic events and mortality. To date, the importance of understanding the relationship between diet and inherited channelopathies has been underrated. Therefore, we describe herein the effects of dietary factors on the development of arrhythmia in patients affected by BrS and LQTS. Modifying the diet might not be enough to fully prevent arrhythmias, but it can help lower the risk.

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“…Reduced blood glucose is a significant indicator of metabolic failure before death. Hypoglycemia-induced bradycardia and sudden death (Nordin 2014;Reno et al 2018) has been associated with ST wave change, lengthening of the QT interval (Robinson et al 2003;D'Imperio et al 2021), and cardiac repolarization (Koivikko et al 2008;Andersen et al 2021). Thus, we suggest that blood glucose must be monitored for all patients who undergo assisted ventilation, and hypoglycemia should be treated immediately with intravenous glucose.…”

Section: Discussionmentioning

confidence: 99%

Physiological and Pathological Evaluation of Mechanically Ventilated Anesthetized Pigs

2023

Int J Vet Sci

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Prolonged assisted ventilation during anesthesia and critical care is associated with increased morbidity and mortality in both humans and animals. However, no study of mechanically ventilated patients has examined the mortality-related physiology and pathology. Our study investigated physiological, hematological and pathological changes in pigs that died during anesthesia. Six pigs were placed under ventilation-assisted anesthesia for up to 48h. The heart rate (HR), respiratory rate (RR), mean arterial blood (MAP), end-tidal carbon dioxide (ETCO2), and oxygen saturation (SpO2) were monitored every 15min until the pigs dies. Blood glucose, serum lactate, pH, and serum bicarbonate (HCO3-) were measured every 12h until death. Tissues were harvested from lung, liver, heart, and kidney of pigs immediately after death during anesthesia. All pigs died during anesthesia. Times of death varied. One pig died at approximately 18h (Group I), two pigs at 24h (Group II), one pig at 36h (Group III), and two pigs at 48h (Group IV). Decreased MAP was reported in all groups throughout anesthesia. Each group showed different changes before death; Group I and III showed decreased blood glucose (45mg/dL) and (17mg/dL), respectively; Group III showed elevated serum lactate (9.76 mmol/l) and reduced pH (7.13) that suggested metabolic acidosis; Group IV showed increased ETCO2 (64.35±5.79 mmHg). Pigs that survived longer showed a higher level of cellular injury to the liver and respiratory system. Blood glucose, MAP, and ETCO2 should be carefully monitored during anesthesia for better patient outcomes and reduced mortality.

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Early Morning QT Prolongation During Hypoglycemia: Only a Matter of Glucose?

Cited by 8 publications

References 42 publications

Brugada Syndrome: Warning of a Systemic Condition?

Brugada Syndrome: Warning of a Systemic Condition?

Impact of Dietary Factors on Brugada Syndrome and Long QT Syndrome

Physiological and Pathological Evaluation of Mechanically Ventilated Anesthetized Pigs

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