title: Cardiovascular safety of antipsychotics: a clinical overview.
abstract: BACKGROUND
  Although antipsychotics have been associated with sudden cardiac death (SCD), they still remain a cornerstone in the treatment of psychiatric patients. Most antipsychotics have an unfavorable cardiovascular adverse effect profile, and SCD may occur even in patients with no cardiovascular risk factors.
  
  
  METHODS
  This clinical overview summarizes the cardiovascular safety of antipsychotics by focusing on the wide range of associated adverse effects. In addition, we also discuss current guidelines regarding routine electrocardiogram (ECG) monitoring.
  
  
  CONCLUSIONS
  As SCD in psychiatric patients is multifactorial, the contribution from antipsychotic treatment remains largely unknown. Cardiovascular adverse effects of antipsychotics vary substantially, even when used in therapeutic doses. Currently, most clinical concern focuses on antipsychotic-induced corrected QT prolongation, as this may increase risk of Torsades de Pointes and eventually SCD. However, other serious cardiovascular adverse effects of antipsychotics also include Brugada syndrome phenotype, myocardial infarction, and myocarditis. Increased awareness of the cardiovascular safety of antipsychotics can allow physicians to better manage and monitor high-risk patients. In this patient group, ECG monitoring may be warranted and other examinations symptom driven. Prescription of antipsychotics should always be a balance between the perceived clinical effect and the burden of adverse effects.
authors.affiliation: a Department of Psychiatry , Aalborg University Hospital , Aalborg , Denmark.|b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark.
authors.forename: Christoffer
authors.initials: C
authors.lastname: Polcwiartek
authors.affiliation: a Department of Psychiatry , Aalborg University Hospital , Aalborg , Denmark.|b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Kragholm
authors.affiliation: a Department of Psychiatry , Aalborg University Hospital , Aalborg , Denmark.|b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Schjerning
authors.affiliation: c Department of Health Science and Technology , Aalborg University , Aalborg , Denmark.
authors.forename: Claus
authors.initials: C
authors.lastname: Graff
authors.affiliation: a Department of Psychiatry , Aalborg University Hospital , Aalborg , Denmark.|b Department of Clinical Medicine , Aalborg University , Aalborg , Denmark.
authors.forename: Jimmi
authors.initials: J
authors.lastname: Nielsen
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D004562:Electrocardiography; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016171:Torsades de Pointes / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents
keywords: Adverse effects; ECG monitoring; QTc prolongation; antipsychotics; cardiovascular safety; sudden cardiac death