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Medikamentös induzierte maligne Arrhythmien

EDV-Prävention verhindert tödliche Mixturen

Drug-induced malignant arrhythmias

IT prevents lethal drug mixtures

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Zusammenfassung

Wir schildern den Fall einer hauptsächlich iatrogen bedingten QTc-Zeitverlängerung durch Kombination verschiedener Medikamente (Methadon, Ondansetron, Escitalopram) mit daraus resultierender reanimationspflichtiger Arrhythmie vom Torsade-de-pointes-Typ. In diesem Zusammenhang werden die Pathophysiologie, mögliche Ursachen und Triggerfaktoren solcher maligner Arrhythmien diskutiert. Als Lehre und Konsequenz aus dieser schweren Komplikation wurden EDV-gestützte Präventionsmaßnahmen entwickelt. Diese basieren auf der Verknüpfung der qtdrugs-Datenbank mit dem elektronischen Medikamenteninteraktionsprüfungsprogramm und auf automatisierten Warnmeldungen an die behandelnden Ärzte bei Erfassung einer verlängerten QTc-Zeit (digitales EKG).

Abstract

We report a case of nearly fatal ventricular tachyarrhythmia type Torsade de pointes caused by medication-induced prolongation of QTc duration (methadone, ondansetron, escitalopram). The etiology, pathophysiology, and trigger mechanisms of such malignant arrhythmias are discussed. In order to prevent similar iatrogenic complications in the future, we networked the qtdrug database with our medication interaction control program and installed an automatic electronic warning system for the physicians in charge in case of a digitally recorded prolonged QTc duration.

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  1. Abteilung für Innere Medizin, Ospidal Gesundheitszentrum Unterengadin, Via da l’Ospidal, 7550, Scuol, Schweiz

    S. Thaler, C. Neumeier &  G. Flury

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  1. S. Thaler
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  2. C. Neumeier
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  3. G. Flury
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Correspondence to G. Flury.

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Thaler, S., Neumeier, C. & Flury, G. Medikamentös induzierte maligne Arrhythmien. Internist 54, 485–490 (2013). https://doi.org/10.1007/s00108-013-3246-3

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