QT Intervals in Psychiatric Practice

This podcast episode discusses the risk of QT prolongation caused by psychiatric medications and its potential to lead to abnormal heart rhythms, specifically Torsade de Pointes. It emphasizes the importance of monitoring high-risk patients, such as those over 65, females, and patients with a history of heart disease, and obtaining baseline electrocardiograms (ECGs) to identify QT prolongation. The episode highlights the impact of different psychiatric medications, including SSRIs like Sitalopram, on QT intervals. It recommends considering alternative non-QT prolonging agents for patients with prolonged QT intervals and consulting with a cardiologist if the QT interval exceeds 500 milliseconds. The episode also highlights the need for regular monitoring of ECGs and electrolyte levels when prescribing certain medications. Overall, it emphasizes the importance of understanding and managing QT prolongation to ensure patient safety when using psychiatric medications. Main points • QT prolongation with psychiatric medications can lead to abnormal heart rhythms. • High-risk patients for QT prolongation should be identified through baseline ECGs and include those over 65, females, and patients with a history of heart disease. • Medications like antiarrhythmics, antibiotics, antihistamines, and antivirals are known for prolonging the QT interval. • Psychiatrists should consider alternative non-QT prolonging agents for patients with a prolonged QT interval. • If the QT interval reaches or exceeds 500 milliseconds, a cardiology consultation is recommended. • Patients with implanted pacemakers and cardioverter defibrillators are not protected against QT prolongation. • Repeat ECGs and electrolyte panels should be done yearly, especially for patients with underlying risk factors like eating disorders and malnutrition. • Different psychiatric medications, including antidepressants, antipsychotics, mood stabilizers, stimulants, and opioids, can impact QT intervals. • Regular monitoring of ECGs and electrolyte levels is recommended when prescribing certain psychiatric medications. • Minimizing concurrent use of QT prolonging medications and considering patient factors is important in prescribing psychiatric medications.