Drug-associated arrhythmia in the military patient

Abstract

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.

Leisure athletes at risk of medical complications: outcomes of pre-participation screening among 15,778 endurance runners - SAFER VII

“…The potential risk of a medical complication during exercise, as a result of prescription medication, can vary greatly and is related to the underlying medical condition is for which the medication is prescribed, and the side effect profile of the medication. Some pharmacological agents may be associated with an increased risk of developing cardiac arrhythmias [35][36][37][38], renal complications including acute renal failure [39], rhabdomyolysis [40,41], gastrointestinal bleeding [42][43][44], and risk of tendon injuries including acute tendon rupture [45,46]. We recommend that a screening tool could be modified to include more specific information about classes of medication that may be associated with increased risk of medical complications during exercise.…”