Long QT interval in severe hypercalcaemia

Ortega-Carnicer, Julián; Ceres, Filomena; Sanabria, Concepción

doi:10.1016/j.resuscitation.2004.01.023

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…To our knowledge, we described the first patient with PHPT, prolonged QT interval, and consequent sustained VT. However, a similar patient with severe hypercalcemia and PHPT had an unexpected long QT interval (but not sustained VT as in our case), secondary to multifactorial polyuria (causing extreme hypokalemia and hypomagnesemia), was also reported ( 10 ). Hypokalemia-induced electrophysiological changes, such as prolonged QT interval, generate a range of arrhythmic triggers including early and delayed after-depolarizations, as well as oscillatory prepotentials in Purkinje ﬁbers ( 11 ).…”

Section: Discussionsupporting

confidence: 59%

Primary hyperparathyroidism associated with acquired long QT interval and ventricular tachycardia

Muzurović

Medenica

Kalezić

et al. 2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary We present a 54-year-old patient admitted to the emergency department due to loss of consciousness. The initial ECG registered monomorphic ventricular extrasystoles and prolonged QT interval (QT corrected (QTc) >500 ms). Sustained ventricular tachycardia (VT) was registered on 24-h Holter ECG monitoring, which clinically was presented as a crisis of consciousness. Coronary angiography and other visualization methods were normal. Implantable cardioverter-defibrillator (ICD) implantation was planned for the purpose of secondary prevention of sudden cardiac death (SCD). Laboratory and hormonal analyzes revealed primary hyperparathyroidism (PHPT), chronic kidney disease, and hypokalemia. Neck ultrasound showed a 25 mm, sharply outlined homogenous tumor mass which was separated from thyroid gland (TG) and exerted a mild impression on lower parts of the left lobe. Dual wash technetium-99m sestamibi parathyroid scintigraphy with single-photon emission CT (SPECT)/CT also showed the uptake of tracer behind the lower half of the left lobe of the TG. Surgical treatment, lower left parathyroidectomy, was performed, and pathohistological analysis verified parathyroid adenoma. The patient was rhythmically and hemodynamically stable for 7 days after surgery, without additional complaints, and was discharged from the hospital. Timely diagnosis of PHPT, correct assessment and surgical treatment, did not lead our patient to unnecessary ICD implantation. Our case suggests an additional intertwining of electrolyte disorders and ventricular arrhythmias in PHPT and more importantly emphasizes the need for caution when indicating ICD, even in patients with the most serious life-threatening arrhythmias. Learning points Electrolyte abnormalities in PHPT can have highly malignant consequences, and the occurrence of hypokalemia in the presence of hypercalcemia is underestimated in PHPT, and the consequences can be life-threatening. Although hypercalcemia causes shortened QT interval, concomitant severe hypokalemia may overcome hypercalcemia and prolong QT interval, even in the absence of structural heart disease or LQTS. Timely diagnosis of PHPT, correct assessment and surgical treatment, do not lead to unnecessary ICD implantation.

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Section: Discussionsupporting

confidence: 59%

Primary hyperparathyroidism associated with acquired long QT interval and ventricular tachycardia

Muzurović

Medenica

Kalezić

et al. 2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Acute Management of Hypercalcemia

et al. 2015

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Perioperative challenges in a primary hyperparathyroid patient with osteitis fibrosa cystic and borderline QTc: a case-based review and practice analysis

2019

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Introduction: Perioperative care of primary hyperparathyroidism patients is a significant challenge. The challenge increases when the preoperative optimization of the patient is suboptimal due to any reason. Concomitant complications like osteitis fibrosa cystic, renal involvement, and multiple electrolyte abnormalities predispose these patients towards multiple morbidities and even mortality during the perioperative period. It is known that the hypercalcemia causes shortened QT, and the inhalational and intravenous anesthesia drug-induced QT prolongation is likely to be buffered. On the other hand, prolonged QTc in primary hyperparathyroid patients in the presence of hypercalcemia is more uncommon, but an extremely challenging situation for anesthesiologists as these patients are more prone to torsadogenesity. Materials and methods: A case-based review is presented in this paper. To review the current practice and opinions, we searched PubMed and Google Scholar using the advanced search engine with the combination index words of primary hyper-parathyroidism, anesthesia, anaesthesia, anesthesia management, and anaesthesia management with a time frame of January 1, 2000, to August 30, 2018. Results: The results are enumerated in the text. Although anesthetic management of primary hyperparathyroid patients is available in the literature, anesthetic management of primary hyperparathyroid patients with prolonged or borderline QTc is not well described. In this paper, we present a case that was successfully managed using Desflurane based minimal flow anesthesia, which is probably also the first of such. Conclusion: Balanced anesthesia with Propofol induction and modern inhalational agents for maintenance and non-depolarizing neuromuscular blockade appears to be safe method of anesthesia.

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Long QT interval in severe hypercalcaemia

Cited by 3 publications

References 5 publications

Primary hyperparathyroidism associated with acquired long QT interval and ventricular tachycardia

Primary hyperparathyroidism associated with acquired long QT interval and ventricular tachycardia

Acute Management of Hypercalcemia

Perioperative challenges in a primary hyperparathyroid patient with osteitis fibrosa cystic and borderline QTc: a case-based review and practice analysis

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