Drug-associated arrhythmia in the military patient.
Members of the Armed Forces may be exposed to drugs, or combinations of drugs, with the potential to prolong the QRS or QT intervals. The effect of this is to increase the likelihood of developing dangerous ventricular tachyarrhythmias, including ventricular tachycardia, torsades de pointes or ventricular fibrillation. Common examples of the pharmacological agents associated include antibiotics, antiemetics and antimalarials. Genetic predisposition, electrolyte disturbance, anaesthesia and trauma may exacerbate the proarrhythmic effect of these medications. Screening of recruits does not detect all those with a genetic predisposition to drug-associated arrhythmias, so vigilance in preventing this iatrogenic disorder and recognising and appropriately managing it when present is important. This article explains the physiological basis of arrhythmogenesis, outlines the clinical features and provides guidance on investigation and management, with particular reference to military patients.
Royal Centre for Defence Medicine, Birmingham, UK Mid Essex Hospitals NHS Trust, Chelmsford, UK.
Barry
B
Evans
Royal Centre for Defence Medicine, Birmingham, UK St George's, University of London, London, UK.
A
A
Cox
Royal Centre for Defence Medicine, Birmingham, UK Royal Brompton Hospital NHS Foundation Trust, London, UK.
E
E
Nicol
Regional Occupational Health Team, Aldershot, UK.
M
M
Patil Mead
St George's, University of London, London, UK.
E
E
Behr
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008889:Military Personnel
CARDIOLOGY; CLINICAL PHARMACOLOGY; TOXICOLOGY