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Medical Forum / General / Cardiology / October 2008Managing AF in the setting of a prolonged QTc interval?
What drugs would be useful for managing AF in the setting of a prolonged QTc interval? I'm guessing diltiazem, verapamil, and digoxin, b/c I haven't seen any evidence that they do prolong the QTc interval from reading studies. The reason I'm asking is b/c I'll be shadowing a cardiologist on Friday, and I want to bone up on my cardiac pharmacotherapy knowledge. He'll be teaching me all sorts of stuff over the next weeks, such as reading ECGs, TTEs, MUGAs, nuclear and non-nuclear stress tests, cardiopulmonary physiology, etc., lots of cool stuff. Btw, what counts as a "prolonged" QTc interval, > 440 ms for men, and > 450 ms for women? Thanks! > What drugs would be useful for managing AF in the setting of a > prolonged QTc interval? I'm guessing diltiazem, verapamil, and [quoted text clipped - 12 lines] > > Thanks! Go read about amiodarone. I'm not saying that it is the most appropriate drug in this case, but you can read about it and have some questions to ask when you meet with this cardiologist. If I remember, you are an undergrad. There's a lot to learn. > > What drugs would be useful for managing AF in the setting of a > > prolonged QTc interval? I'm guessing diltiazem, verapamil, and [quoted text clipped - 19 lines] > > - Show quoted text - For managing in the acute scenario, of course I'd use amiodarone, just like everyone else. But I'm talking about for long-term management; amiodarone can have some pretty nasty side-effects. Verapamil or diltiazem would have less side-effects and not prolong the QTc. > > > What drugs would be useful for managing AF in the setting of a > > > prolonged QTc interval? I'm guessing diltiazem, verapamil, and [quoted text clipped - 24 lines] > amiodarone can have some pretty nasty side-effects. Verapamil or > diltiazem would have less side-effects and not prolong the QTc. You have a lot to learn, Douglas. Don't come off as a smart a.s to the cardiologist you are going to shadow. He's had years more training and practical experience than you have. A little bit of medical knowledge misapplied is a dangerous thing. Especially when accompanied by arrogance. Truth <yamantaka@aol.com> wrote in news:12ed186b-663b-4938-96b8- 003810e4bb7a@u46g2000hsc.googlegroups.com: >> > > What drugs would be useful for managing AF in the setting of a >> > > prolonged QTc interval? I'm guessing diltiazem, verapamil, and [quoted text clipped - 30 lines] > misapplied is a dangerous thing. Especially when accompanied by > arrogance. I don't see where Douglas has appeared arrogant in this thread, or written anything to warrant this seeming attack. H. > Truth <yamant...@aol.com> wrote in news:12ed186b-663b-4938-96b8- > 003810e4b...@u46g2000hsc.googlegroups.com: [quoted text clipped - 45 lines] > > - Show quoted text - Yes, and besides, do you want me to come off as completely clueless? What's wrong w/ researching the pharmaceuticals involved, as well as diseases and conditions, and how to interpret diagnostics? Don't you want me to appear interested in the field w/ a passion? What if you came to a rotation in medical school and followed your own advice; what would your attending think? Would he think you're very interested in medicine? And beside, he said he'll be quizzing me on stuff like this. My Mom, an RN, also told me to thouroughly research things like this. > > Truth <yamant...@aol.com> wrote in news:12ed186b-663b-4938-96b8- > > 003810e4b...@u46g2000hsc.googlegroups.com: [quoted text clipped - 56 lines] > And beside, he said he'll be quizzing me on stuff like this. My Mom, > an RN, also told me to thouroughly research things like this. Why don't you start off then by explaining here what the Q and T are and how they apply to the stages of function of the heart during its cycles? Please describe it here so that we can see you have grasped that concept first. You're 17 years old, correct? If you start talking to the cardiologist with lines like, "of course I'd use amiodorone just like everyone else" you won't get far with an experienced cardiologist. Yes, appear interested but appropriate to your level of education and experience. I went to medical school before you were even born. You rhetorical question about my medical school years has no place at all in this discussion. It's not my intention to "attack" you. Take my advice or leave it. I don't care. > > > Truth <yamant...@aol.com> wrote in news:12ed186b-663b-4938-96b8- > > > 003810e4b...@u46g2000hsc.googlegroups.com: [quoted text clipped - 72 lines] > > - Show quoted text - Yes, I do know what the waves on an ECG mean: P is atrial depolarization, Q is the first downward deflection after the P wave, R is ventricular depolarization, S is the first downward deflection after the R-wave, and T is ventricular repolarization. And of course I wouldn't spout off lines like that. I'm not a moron. This is what the cardiologist said to me "Wow, I'd love to help you further your knowledge; you seem more knowledgeable about cardiology then some of the med students I get." Please don't underestimate my knowledge. The cardiologist I'm shadowing sure didn't. > > > > Truth <yamant...@aol.com> wrote in news:12ed186b-663b-4938-96b8- > > > > 003810e4b...@u46g2000hsc.googlegroups.com: [quoted text clipped - 86 lines] > Please don't underestimate my knowledge. The cardiologist I'm > shadowing sure didn't. But you spouted off that line here, to me. There's a difference between knowledge / intelligence and knowledge from experience. This cardiologist doesn't expect you to respond like a cardiology fellow, resident or even a medical student. If you are intelligent and interested it will show. Just beware that a little bit of knowledge from reading a book or article is no match for years of having read books, articles, attended conferences and treated thousands of patients. In the past in your posts I have detected arrogance. > > > > > Truth <yamant...@aol.com> wrote in news:12ed186b-663b-4938-96b8- > > > > > 003810e4b...@u46g2000hsc.googlegroups.com: [quoted text clipped - 99 lines] > > - Show quoted text - Okay. |
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