ECG and antipsychotics

[muffinlove]

Has anyone has had changes in their ecg when on antipsychotics? My corrected QT is now borderline it being fine before.

Some of them come with a risk of causing prolonged qt syndrome. I've been on quetiapine for over 12 years and never had regular ECG. I had a 24h one after an illness sent my resting heart rate to 160 and I had several in hospital around the time of starting lithium but otherwise it's not something my drs have been monitoring but I do know that they come with the risk.
What has your Dr suggested?

Gp wrote psychiatrist to ask advice. I have routine ecg once a year. I also have bloods and weight no etc taken once a year. I have lithium bloods every three months

I think you need to have above if you have polypharma.

I have bloods and weight done every year and always have done on mono therapy or polypharmacy but the only time I've had ECGs is whilst inpatient and like 4 in 2 months. I was on 4 medications for a while with multiple prolonged qt risks and no ECGs!

My daughters on multiple meds for other issues including some with prolonged qt risk and under consultant care but no ECGs. I won't lie it does make me nervous!

Hopefully the Dr gets back to your GP soon. They might make a switch to a different medication or reduce the dose. I know when they want my lithium levels at 1.0 they couldn't increase until an ECG showed no issues and then again when it went up to 1.2 and I got a tremor

I have been on lithium 13 years and on Lurasidone antipsychotic for seven. I have had ecg yearly without problems in til now.

@Superscientist Apple Watch records ecg. I got one to follow mine and it has shown I have long qt in some measurements.

Do you know which antipsychotics have this? I’m on Risperidone and Aripiprazole. Supposed to be stopping Risperidone due to potential raised prolactin issues, but I keep having relapses when it’s reduced. I’ve never had a routine ecg.

Get your GP to do an advice and guidance query to cardiology as well!

Most of the antipsychotic do to varying degrees. Some are lower risk at therapeutic doses.
I have found this NHS advice page which might be useful. It has a flow chart for what action is advised and which medication are low/high risk. Obviously take advice from your drs in preference to this document! <a class="break-all" href="https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=www.england.nhs.uk/north/wp-content/uploads/sites/5/2018/12/QTc-flow-diagram-with-medications-final-Dec-17-A3-with-logos.pdf&ved=2ahUKEwiYiubLxZWLAxUPQ0EAHYEmNfYQFnoECDUQAQ&usg=AOvVaw0O8bCIQ0HRi7reEr140zZH" rel="nofollow" target="_blank">NHS England www.england.nhs.ukPDF Guidelines for the Management of QTc Prolongation in Adults

Promazine gave me the worst scare if my life, it triggered not only long QT syndrome but tachy-brady syndrome - they were gonna fit a pace maker ( I was 25) before they realised it was the promazine !!!

I think a lot of people are not getting the reviews, checks and care they should be https://news.liverpool.ac.uk/2024/11/26/researchers-warn-360000-patients-in-the-uk-risk-being-trapped-on-antipsychotics/

Is that an automated ECG analysis because it is meaningless to me. Unless that is corrected for heart rate. In that case it depends on which formula is used, different formulae give different (although very similar) results. This will be reported at QTc, QTb or QTf.

QT is the duration from the q or R wave to the end of the T wave, so it can lengthen and shorten in response to various things including medication.

T waves can also change shape and invert.

It was corrected qt

But corrected for what?

I don't know. That was all mentioned in my NHS app. I can't access the ecg report.

OK so lets assume it is corrected for heart rate.

The QT interval normally varies with HR, as your HR increases the QT interval shortens, increases can be caused by any movement or physiological changes so running will put your HR up by a lot, digestion uses less energy but can still increase your HR.

At rest your HR goes lower and your QT interval increases.

What worries Drs is when the QT interval gets too long.

OK a bit of science here. In non scientific language, sorry if I sound patronising, I have no idea of how much physiology you know.

An ECG does not actually record your HR it records the electrical activity in your heart.

Your heart has its own 'wiring system' that makes the different parts of the heart depolorise and that depolarisation causes the heart to contract.

After depolarisation there is a slight pause and then repolarisation. The RS is the depolarisation of the ventricles and the T wave is the repolarisation.

Now although your heart has this wiring system as a back up every part of your heart can depolorise on its own. This is when you get an ectopic beat,

This is not a problem for a one off but if the QT interval gets too long the ventricles are still repolarising while the atria are depolarising. This can lead to arrhythmias.

Now having said all that what is your QT interval at rest? That is what matters most.

Obviously listen to your Drs, you may or ay not get a referral to cardiology, the reason I'm saying that is because if the auto readout is borderline a cardiologist will be able to say if it is anything to worry about.

Remember that in medicine there are lots of things that are 'abnormal' but don't cause any problems.

I'm only 5ft 0, so I am abnormally short for an adult caucasian woman. But it doesn't make me ill.