Psychotropic medications and the risk of sudden cardiac death during an acute coronary event

Abstract

The use of psychotropic drugs, especially combined use of antipsychotic and antidepressant drugs, is strongly associated with an increased risk of SCD at the time of an acute coronary event.

Temporal Trends in the Clinical and Pathological Characteristics of Victims of Sudden Cardiac Death in the Absence of Previously Identified Heart Disease

“…The study started in 1998, and the design has been previously reported in detail. [16][17][18][19] The study population consists of prospective accumulation of (n=4031; without previous heart disease n=2697) consecutive white victims of SCD in the Province of Oulu, Northern Finland, on whom postmortem examinations were performed at the Department of Forensic Medicine of the University of Oulu between 1998 and 2012. The sudden death autopsy rate in Finland is the highest in Western societies.…”

“…[19][20][21] The determination of the cause of death and information about the medical history including drug therapy of the victims of SCD were based on a combination of death certificates, medical records, autopsy data, and the result of a standardized questionnaire completed by the closest family members of the victims of sudden death. [16][17][18][19] The data were collected prospectively and stored at the coordinating center of the Medical Research Center Oulu, University of Oulu. A previously described method for classification of causes of SCD 19 was used for detailed descriptions of the underlying cardiac disease based on postmortem findings, in conjunction with data obtained from medical records and specific questionnaires completed by relatives.…”

Patrones de prescripción de antipsicóticos en pacientes afiliados al Sistema de Seguridad Social en Salud de Colombia

“…Al inferir sobre las enfermedades asociadas a partir de la 'comedicación' prescrita, se encontró que la depresión y los trastornos de ansiedad, son las más prevalentes, 32,5 % y 26,0 %, respectivamente, cifras similares a las encontradas en otros estudios (26,27). Se deben tener en cuenta las potenciales interacciones con los antidepresivos, ya que algunos de estos pueden prolongar el intervalo QT y producir muerte súbita cardiaca en los pacientes con antecedentes de riesgo cardiovascular, y provocar mayores efectos de tipo anticolinérgico, principalmente los antidepresivos tricíclicos (26).…”

“…Se deben tener en cuenta las potenciales interacciones con los antidepresivos, ya que algunos de estos pueden prolongar el intervalo QT y producir muerte súbita cardiaca en los pacientes con antecedentes de riesgo cardiovascular, y provocar mayores efectos de tipo anticolinérgico, principalmente los antidepresivos tricíclicos (26). La evaluación de la relación riesgo-beneficio de esta asociación, debe contemplar que los antidepresivos parecen reducir el riesgo de suicidio en los pacientes psicóticos, en contraste con la 'comedicación' de ansiolíticos, que lo aumenta (27).…”

Sudden Cardiac Death Related to Antipsychotics

“…5 Second, QTc lengthening induced by the majority of antipsychotics is indeed minimal (ie, a few milliseconds)-rarely able to exceed the threshold for LQTS. 6 Third, postmortem data indicate 2 different pathophysiologic mechanisms that cause SCDs with antipsychotic treatment: (1) SCDs preceded by an acute coronary event or linked to a structural heart disease, which occurs in a larger number of patients and is especially characteristic of the middle-aged and elderly, 7,8 and (2) SCDs linked to primary arrhythmic events, which occur less frequently and are especially characteristic of younger people. 1 Therefore, focusing on acquired LQTS and TdP, we are now most likely to be preventing only a few of these deaths, with an apparent sense of safety in subjects with a normal QT interval duration.…”