title: Secondly ECG recordings in the emergency room revealed Garenoxacin-induced abnormal QT interval prolongation in a patient with multiple syncopal attacks.
abstract: A 73-year-old woman first visited our emergency room with multiple syncopal attacks. Before admission, she had received an antibiotic (Garenoxacin) for 3 days from a local clinic. First electrocardiogram (ECG) showed no ST-segment deviation but mild QT interval prolongation with a positive U wave. Second ECG recording 3 h later showed slightly slower heart rate and revealed marked QTU interval prolongation suggesting the cause of her syncopal attacks. After cessation of Garenoxacin, the QTU interval prolongation shortened. However, both epinephrine infusion and treadmill exercise test reproduced similar QTU interval prolongation and T wave deformities. Later, genetic analysis demonstrated that this patient had a mutation in KCNH2 gene, and she was diagnosed as a type-2 long-QT syndrome which was accentuated by use of garenoxacin. At the emergency out-patient clinic, repetitive ECG recordings can be useful and should be considered in order to identify the cause of syncopal attacks in patients who were prescribed antibiotics and had mild QT interval abnormalities.
authors.affiliation: Department of Cardiology, Nagaoka Chuo General Hospital, Nagaoka, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Tagawa
authors.affiliation: Department of Cardiology, Nagaoka Chuo General Hospital, Nagaoka, Japan.
authors.forename: Sachie
authors.initials: S
authors.lastname: Ochiai
authors.affiliation: Department of Cardiology, Nagaoka Chuo General Hospital, Nagaoka, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Cardiovascular Biology and Medicine, Niigata University School of Medicine, Niigata, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Sato
authors.affiliation: School of Health Science, Niigata University School of Medicine, 2-746 Asahimachi, Chuou-ku, Niigata, 951-8518, Japan. masaomi@clg.niigata-u.ac.jp.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Chinushi
mesh_terms: D000322:Adrenergic Agonists / Q000008:administration & dosage; D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000072237:ERG1 Potassium Channel / Q000235:genetics; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000008:administration & dosage; D005080:Exercise Test; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects*; D020022:Genetic Predisposition to Disease; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008133:Long QT Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics / Q000503:physiopathology; D008790:Metoprolol / Q000627:therapeutic use; D009154:Mutation; D010641:Phenotype; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D013575:Syncope / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D000322:Adrenergic Agonists; D058671:Adrenergic beta-1 Receptor Antagonists; D000900:Anti-Bacterial Agents; D000072237:ERG1 Potassium Channel; D024841:Fluoroquinolones; C000606913:KCNH2 protein, human; D008790:Metoprolol; C419689:garenoxacin; D004837:Epinephrine
keywords: Garenoxacin; Long-QT syndrome; Syncope