Everything the Psychiatrist Needs to Know about ECGs-View Presentation

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Video Summary

In a comprehensive clinical workshop, Dr. Margo Funk, a psychiatrist from Harvard Medical School, focused on the essentials of electrocardiograms (ECGs) for psychiatrists, particularly concerning the risk of QT interval prolongation and torsades de pointes when prescribing psychotropic medications. The session included detailed instruction on identifying and interpreting ECG intervals, notably the QT and JT intervals, and highlighted the unreliability of the Bizette formula for heart rate correction, promoting alternative formulas like Hodges, Fredricia, or Framingham.<br /><br />Dr. Funk emphasized the intricacies of drug-induced QT prolongation, underscoring that while most QTC prolongations from psychiatric medications rarely lead to torsades without other risk factors, vigilant risk assessment remains crucial. The talk also reviewed several psychotropic medications, noting citalopram's historical scrutiny and affirming the relative safety of other SSRIs, SNRIs, and mood stabilizers under typical prescribing conditions.<br /><br />A key consideration was the additive risk when patients are on multiple QT-prolonging medications, especially in complex medically ill populations. Dr. Funk suggested balancing potential risks against therapeutic benefits, often involving consultation with cardiologists, especially when QTC exceeds 500 milliseconds or when ECG morphology raises concerns.<br /><br />Additional focus was placed on managing patients with implanted devices like ICDs or pacemakers, with specific guidance on adjusting QT assessment techniques. Overall, the session empowered psychiatrists with the tools to confidently assess and manage cardiac risks associated with psychiatric medications, urging continual practice and consultation where necessary to enhance clinical outcomes.

Keywords

ECG

QT interval

torsades de pointes

psychotropic medications

psychiatry

QT prolongation

citalopram

SSRIs

SNRIs

risk assessment

cardiac risks

implanted devices

psychiatric medications