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American Journal of Critical Care. 2002;11: 395-396
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ECG PUZZLER
A regular feature of the American Journal of Critical Care, the ECG Puzzler addresses ECG interpretation for clinical practice. We welcome letters to the Editors regarding this feature.

A Class III Antiarrhythmic Agent

By Michele M. Pelter, RN, PhD and Mary G. Adams, RN, PhD. From the Department of Physiological Nursing, University of California, San Francisco, Calif (MMP), and the School of Nursing, the State University of New York at Buffalo (MGA).

Scenario: A 72-year-old woman presents to the emergency department with complaints of dizziness. She is currently under the care of a cardiologist for ventricular arrhythmias and admits that she is "a bit confused about her daily dose" of amiodarone. Bedside monitoring is initiated, and the ECG technician is on his way to obtain a 12-lead ECG.



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Interpretation: Sinus bradycardia with sinus pause or sinus arrest with long Q-T interval.

Rationale

The main concern for this patient is the long pause unrelieved by a lower pacemaker escape beat (junctional or ventricular). Without a direct recording of sinus nodal activity, it is difficult to distinguish between sinus pause and sinus arrest. This rhythm is likely due to amiodarone toxicity, given her poor recall of drug usage and lengthened Q-T interval.

There are 2 general types of long Q-T syndrome: (1) acquired and (2) congenital. The causes of acquired long Q-T interval include various drugs such as quinidine, amiodarone, sotalol, procainamide, and nonsedating antihistamines; electrolyte abnormalities such as hypokalemia and hypomagnesemia; liquid protein diet and starvation; and mitral valve prolapse. Congenital long Q-T syndrome (idiopathic), on the other hand, is a familial disorder.

Nursing Actions

Notify the physician of profound bradycardia and long Q-T interval. The cause of the symptomatic bradycardia in this patient is amiodarone toxicity; therefore, cessation of this drug is mandatory. Class IB antiarrhythmic drugs and atrial or ventricular pacing to increase heart rate may be used to shorten the Q-T interval. Monitor this patient for torsades des pointes, which is treated with intravenous magnesium.





This Article
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Google Scholar
Right arrow Articles by Pelter, M. M.
Right arrow Articles by Adams, M. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pelter, M. M.
Right arrow Articles by Adams, M. G.

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