Psychotropic Drugs Cause Sudden Cardiac Arrest

By 21 September 2017GBH - SUDDEN CARDIAC ARREST
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Psychotropic Drugs Cause Sudden Cardiac Arrest √

Published on 21st September 2017
Joseph-S-R-de-Saram

Joseph S R de Saram (JSRDS)

Information Security Architect / Intelligence Analyst / Computer Scientist / Human Rights Activist / COMSEC / SIGINT / TSCM
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In October 1991 I entered University College London Medical School to study Medicine:-

Our consultancy unit harnesses the Medical School’s expertise to offer a range of consultancy services that enable, inform and support high-quality, scientifically rigorous and patient focused education for doctors.

We work in partnership with our clients around the globe to deliver health gain through education: by co-developing context-specific solutions that transform programmes, administrative systems, learning environments and the student experience "It is......

I have to say I was clowning around most of the time dating Radiologists, Pharmacists and Nurses (female ones obviously) and it was the only way I ended up learning anything. I therefore passed Anatomy and Pharmacology, and have had a solid knowledge ever since.

Around 1992 a girlfriend of mine who was working at Accident & Emergency at University College Hospital told me about a young man who was healthy but had suddenly died for no apparent reason – Sudden Cardiac Death (“SCD”) as it was called. The man’s heart had definitely stopped but there was no blockage found in the subsequent autopsy.

I was trying to ‘get in with the girl’ so I went off to research some possible causes, before the next outing to the Happy Garden restaurant in Leicester Square.

For the record I am not someone who cares what people think about them but I did like to impress pretty girls at that time. This weakness is a risk in counter-surveillance work as ‘honey-traps’ though I was hanging out with ‘modelly-types’ at the time. However once the work started I could not be bought or lured 🙂

A couple of medical students were in my ‘gang’, Nick Britchford and Sian Field. Sian wanted to be a Paediatrician so I told her about the A&E case and she referred me to an article (May 1991) about sudden death in children:-

Journal of the American Academy of Child & Adolescent Psychiatry – May 1991

Sudden Death in Children Treated with a Tricyclic Antidepressant - ScienceDirect

...

Having read that I found this one:-

Acta Psychiatrica Scandinavica – July 1991

A survey of sudden death associated with the use of antipsychotic or antidepressant drugs: 49 cases in Finland

Phenothiazines have repeatedly been found to be associated with cases of sudden death, but the issue of causality has remained controversial. A survey of medicolegal autopsies performed in Finland over...

and from that point onwards I knew about the issues of psychotropic medication and sudden cardiac death. It was one of those things that stuck in my mind, but something that every doctor, and especially psychiatrists know very well, that

* PSYCHOTROPIC MEDICATION CAUSES SUDDEN CARDIAC DEATH *

Sudden Cardiac Arrest (“SCA”)

People often use the terms Heart Attack and Sudden Cardiac Arrest interchangeably, but they are not synonyms. A heart attack is when blood flow to the heart is blocked, and sudden cardiac arrest is when the heart malfunctions and suddenly stops beating unexpectedly. A heart attack is a “circulation” problem and sudden cardiac arrest is an “electrical” problem.

What is a Heart Attack?

A heart attack occurs when a blocked artery prevents oxygen-rich blood from reaching a section of the heart. If the blocked artery is not reopened quickly, the part of the heart normally nourished by that artery begins to die. The longer a person goes without treatment, the greater the damage. Symptoms of a heart attack may be immediate and intense. More often, though, symptoms start slowly and persist for hours, days or weeks before a heart attack. Unlike with sudden cardiac arrest, the heart usually does not stop beating during a heart attack. The heart attack symptoms in women can be different than men.

What is Cardiac Arrest?

Sudden cardiac arrest occurs suddenly and often without warning. It is triggered by an ELECTRICAL MALFUNCTION in the heart that causes an irregular heartbeat (arrhythmia).

With its pumping action disrupted, the heart cannot pump blood to the brain, lungs and other organs. Seconds later, A PERSON LOSES CONSCIOUSNESS and has no pulse. Death occurs within minutes if the victim does not receive treatment.

What is the link?

These two distinct heart conditions are linked. Sudden cardiac arrest can occur after a heart attack, or during recovery. Heart attacks increase the risk for sudden cardiac arrest. Most heart attacks do not lead to sudden cardiac arrest. But when sudden cardiac arrest occurs, heart attack is a common cause. Other heart conditions may also disrupt the heart’s rhythm and lead to sudden cardiac arrest. These include a thickened heart muscle (cardiomyopathy), heart failure, arrhythmias, particularly ventricular fibrillation, and long Q-T syndrome.

American Heart Association – September 2016

Heart Attack or Sudden Cardiac Arrest: How Are They Different?

People often use the terms heart attack and cardiac arrest interchangeably, but they are not synonyms. The American Heart Association explains the difference between the two and what to do in each case....

The Role of Psychotropic Medication

Since psychotropic medication does not result in a ‘blockage’ then any ‘heart stoppage’ is due to an electrical issue. The mechanisms by which psychotropic medication cause Sudden Cardiac Death are not well known,

it is obviously unsafe to prescribe psychotropic medication to anyone who has any cardiovascular issues whatsoever.

Medical Journals from 1992

The Right to 'Just Say No': A History and Analysis of the Right to Refuse Antipsychotic Drugs

The article presents a complex history of the disordered development of the right to refuse antipsychotic drugs and attempts to analyze the complex legal, medic...

Medical Journals from 1993

Review of Psychosomatic Aspects of Cardiovascular Disease

This review deals with the clinically most relevant psychosomatic aspects of cardiovascular disease. Smoking cessation, the role of physical activity in the prevention and rehabilitation of cardiac disease, the relationship of cholesterol to behavior...

Sudden Cardiac Death: Epidemiology, Transient Risk, and Intervention Assessment

Purpose: To integrate information from the various disciplines that contribute to the understanding of the cause and prevention of sudden cardiac death: identification of new approaches from applied clinical epidemiology; identification and control of transient risk factors; and evaluation of the results of interventions.

Medical Journals from 1995

Sudden death, neuroleptics and psychotic agitation

1. 1. The concept of “neuroleptic death” as a phenomenologically valid entity is still in controversy. The present paper describes 13 cases of sudden, unexpected and unexplained deaths among psychiatric inpatients that might be attribute to...

Medical Journals from 1996

Sudden Death from Cardiac Causes in Children and Young Adults — NEJM

Review Article from The New England Journal of Medicine — Sudden Death from Cardiac Causes in Children and Young Adults...

The QT interval and the atypical antipsychotic, sertindole

(1998). The QT interval and the atypical antipsychotic, sertindole. International Journal of Psychiatry in Clinical Practice: Vol. 2, No. 4, pp. 265-273. doi: 10.3109/13651509809115372

Long QT syndromes and torsade de pointes

In the long QT syndromes (LQTS), malfunction of ion channels impairs ventricular repolarisation and triggers a characteristic ventricular-tachyarrhythmia: torsade de pointes. Symptoms in the LQTS (syncope or cardiac arrest) are caused by this...

Sudden Cardiac Death With Apparently Normal Heart

Background—Mechanisms of sudden cardiac death (SCD) in subjects with apparently normal hearts are poorly understood. In survivors, clinical investigations may not establish normal cardiac structure with certainty. Large autopsy series may provide a...

Sudden Cardiac Death and Antipsychotic Drugs

ANTIPSYCHOTIC drugs have revolutionized the treatment of psychotic and mood disorders since their introduction 50 years ago. Although psychiatric patients have significantly benefited from the use of typical antipsychotic drugs, their limitations have...

Sudden Death Due to Cardiac Arrhythmias — NEJM

Review Article from The New England Journal of Medicine — Sudden Death Due to Cardiac Arrhythmias...

Antipsychotics and the risk of sudden cardiac death.

Arch Gen Psychiatry. 2001 Dec;58(12):1 161-7. Comparative Study; Research Support, U.S. Gov't, P.H.S....

Medical Journals from 2002

Antipsychotic-Related QTc Prolongation, Torsade de Pointes and Sudden Death

Sudden unexpected deaths have been reported with antipsychotic use since the early 1960s. In some cases the antipsychotic may be unrelated to death, but in others it appears to be a causal factor. Antipsychotics can cause sudden death by several mechanisms, but particular interest has centred on torsade de pointes (TdP), a polymorphic...

Cardiac arrest and ventricular arrhythmia in patients taking antipsychotic drugs: cohort study using administrative data

Many antipsychotic drugs can prolong the QT interval, and many have been linked to cases of torsade de pointes. 1 Although QT prolongation is commonly used to predict a drug's potential for arrhythmogenicity, 2 several factors about this marker...

and

http://psycnet.apa.org/record/2002-17116-002

Medical Journals from 2003

and

Fatalities Associated with Therapeutic Use and Overdose of Atypical Antipsychotics

Since 1989, several novel antipsychotic drugs have become available for use including clozapine, risperidone, olanzapine, quetiapine and ziprasidone. These agents represent a substantial improvement i...

Cyclic antidepressants and the risk of sudden cardiac death

Tricyclic and other related cyclic antidepressants (TCAs), used frequently for the treatment of depression and several other indications, have cardiovascular effects that may increase the risk of sudden......

Genomics in Sudden Cardiac Death

Sudden cardiac death (SCD) remains a public health problem of major magnitude. Contrary to earlier expectations, and despite decreased overall cardiac mortality, SCD rates appear to be rising in concert with escalating global prevalence of coronary......

Atypical Antipsychotics

Syncope and sudden death are features of schizophrenia that can be attributed to ischaemic heart disease, the use of antipsychotics (because of proarrhythmia or other reasons such as pharyngeal dyskin

Medical Journals from 2006

BJPsych Advances

Mortality from causes other than suicide is higher than expected in schizophrenia. Cardiovascular causes are most common, accounting for the majority of the 5% of sudden and unexpected deaths. Most cases have no clear explanation on post-mortem......
Cambridge Core

Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs.

Abstract: OBJECTIVE: To examine the relationship between presence of metabolic syndrome and the risk of coronary heart disease (CHD) events (angina...

and

Sudden cardiac death in schizophrenia: should the psychiatrist pay more attention?

http://dx.doi.org/10.1590/S1516-44462006000400016

Morte súbita cardíaca na esquizofrenia: o psiquiatra deve estar atento? Sudden cardiac death in schizophrenia: should the psychiatrist pay more attention? A relação entre morte súbita e esquizofrenia tem recebido crescente atenção. A incidência de...

Atypical Antipsychotics

Syncope and sudden death are features of schizophrenia that can be attributed to ischaemic heart disease, the use of antipsychotics (because of proarrhythmia or other reasons such as pharyngeal dyskin

Cardiovascular risks of atypical antipsychotic drug treatment

Atypical antipsychotics are the treatment of choice for patients with schizophrenia. They are generally better tolerated than conventional antipsychotics since most do not cause debilitating extrapyramidal...

Medical Journals from 2008

Sudden cardiac death secondary to antidepressant and antipsychotic drugs

(2008). Sudden cardiac death secondary to antidepressant and antipsychotic drugs. Expert Opinion on Drug Safety: Vol. 7, No. 2, pp. 181-194. doi: 10.1517/14740338.7.2.181...

Schizophrenia and sudden cardiac death—A review

(2008). Schizophrenia and sudden cardiac death—A review. Nordic Journal of Psychiatry: Vol. 62, No. 5, pp. 342-345. doi: 10.1080/08039480801959323...

Potential Causes of Higher Mortality in Elderly Users of Conventional and Atypical Antipsychotic Medications

OBJECTIVES: To investigate the potential mechanisms through which conventional antipsychotic medication (APM) might act, the specific causes of death in elderly patients newly started on conventional APM...

Medical Journals from 2009

Potential Causes of Higher Mortality in Elderly Users of Conventional and Atypical Antipsychotic Medications

OBJECTIVES: To investigate the potential mechanisms through which conventional antipsychotic medication (APM) might act, the specific causes of death in elderly patients newly started on conventional APM...

Antipsychotic Agents and Sudden Cardiac Death — How Should We Manage the Risk?

Antipsychotic medications are commonly used across the entire age spectrum, both within and outside their labeled (and evidence-based) indications.1,2 Three atypical antipsychotic medications, olanzapine (Zyprexa, Eli Lilly), risperidone (Risperdal, Janssen), and quetiapine (Seroquel, AstraZeneca) are among the 10 top-selling drugs worldwide, with a combined sales volume of $14.5 billion in 2007.3

Proarrhythmic Risk with Antipsychotic and Antidepressant Drugs

The quinidine-like effects of some antidepressant drugs (particularly tricyclic antidepressants) and many antipsychotic drugs (particularly the phenothiazines) confound treatment of psychosis and depr...

Antipsychotic-induced sudden cardiac death: examination of an atypical reaction

(2009). Antipsychotic-induced sudden cardiac death: examination of an atypical reaction. Expert Opinion on Drug Safety: Vol. 8, No. 3, pp. 249-252. doi: 10.1517/14740330902936846...

Medical Journals from 2010

Antipsychotic-induced sudden cardiac death: examination of an atypical reaction

Objective To assess whether use of the antidepressant venlafaxine is associated with an increased risk of sudden cardiac death or near death compared with other commonly used antidepressants. Design Population based observational study. Setting We did...

and

http://journals.lww.com/headtraumarehab/Citation/2010/01000/Sudden_Cardiac_Death_and_Stroke_With_the_Use_of.9.aspx

Medical Journals from 2011

European Heart Journal – February 2011

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

Jussi Honkola1, Eeva Hookana1, Sanna Malinen1, Kari S. Kaikkonen1, M. Juhani Junttila1, Matti Isohanni2, Marja-Leena Kortelainen3, and Heikki V. Huikuri1* 1 Department of Internal Medicine, Institute of Clinical Medicine, University of Oulu, PO Box 5000, Oulu 90014, Finland; 2 Department of Psychiatry, University of Oulu, Oulu, Finland; and 3 Department of Forensic Medicine, University of Oulu, Oulu, Finland Received 22 February 2011; revised 19 May 2011; accepted 24 August 2011; online publish-ahead-of-print 14 September 2011 See page 687 for the editorial comment on this article (doi:10.1093/eurheartj/ehr405).

Aims

PSYCHOTROPIC MEDICATION INCREASES CARDIAC MORTALITY

but the reasons for this association are not clear. We studied the role of psychotropic drugs as a triggering factor of sudden cardiac death (SCD) during an acute coronary event.

Methods and results

The use of medication was compared between victims of SCD and survivors of an acute coronary event in a case– control study including a consecutive series of victims of SCD (n ¼ 1814, mean age 65+11 years) verified to be due to an acute coronary event at medico-legal autopsy and consecutive series of patients surviving an acute myocardial infarction (AMI; n ¼ 1171, mean age 66+12 years). The medication history was obtained from autopsy/hospital records and interviews with relatives of SCD victims and AMI patients. The use of antipsychotics [9.7 vs. 2.4%, odds ratio (OR) 4.4, 95% confidence interval (CI) 2.9–6.6; P , 0.001] and antidepressants (8.6 vs. 5.5%, OR: 1.6, 95% CI: 1.2–2.2; P ¼ 0.003) was more common in the SCD than AMI group, but the use of benzodiazepines did not differ between the groups (11.7 vs. 13.2%; P ¼ 0.270).

The use of antipsychotics remained as a significant risk factor for SCD after adjustment for confounding variables (OR: 3.4, 95% CI: 1.8–6.5; P , 0.001). Combined use of phenothiazines and any antidepressant was associated with a very high risk of SCD (OR: 18.3, 95% CI: 2.5– 135.3; P , 0.001).

Keywords Myocardial infarction † Psychiatric disorder † Sudden death

Cohort Study of Incidence of Sudden Unexplained Death in Persons with Seizure Disorder Treated with Antiepileptic Drugs in Saskatchewan, Canada

Summary: To measure the incidence of sudden unexplained death in treated persons with epilepsy (SUDEP) and to identify risk factors for SUDEP, a cohort of 6,044 persons aged 15–49 years with more than...

Antidepressants and the risk of sudden cardiac death and ventricular arrhythmia

To examine the association between exposure to antidepressants and emergency department or inpatient admission for sudden cardiac death and ventricular arrhythmia (SD/VA), and to examine the impact of......

Sudden unexpected death in schizophrenia: Autopsy findings in psychiatric inpatients

Schizophrenia is associated with premature mortality and a high rate of sudden, unexpected deaths. Autopsy data are scant, and in studies using death certificates or root cause assessments, a majority of sudden deaths remained unexplained. In the community, post-mortem data indicate that the most common cause of sudden “natural” death is coronary artery disease.

Antipsychotics and Associated Risk of Out‐of‐Hospital Cardiac Arrest

Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out–of–hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear....

Medical Journals from 2015

Antipsychotic Drugs and the Risk of Ventricular Arrhythmia and/or Sudden Cardiac Death: A Nation‐wide Case‐Crossover Study

Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan (C.S.W.) College of Public Health, National Taiwan University, Taipei, Taiwan (C.S.W.) Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan (C.S.W.

Risk factors for sudden cardiac death among patients with schizophrenia

Patients with schizophrenia suffer from excessive premature mortality, and sudden cardiac death (SCD) is receiving growing attention as a potential cause. We enrolled a consecutive series of 8264 patients diagnosed with schizophrenia (according to...

Psychotropic medications and the risk of sudden cardiac death during an acute coronary event | European Heart Journal | Oxford Academic

AimsPsychotropic medication increases cardiac mortality, but the reasons for this association are not clear. We studied the role of psychotropic drugs as a triggering factor of sudden cardiac death (SCD) during an acute coronary event.Methods and...

Conclusion

The use of psychotropic drugs, is

STRONGLY ASSOCIATED with an INCREASED RISK OF SUDDEN CARDIAC DEATH at the time of an ACUTE CORONARY EVENT.

Interesting isn’t it? The case continues…

Joseph-S-R-de-Saram

Joseph S R de Saram (JSRDS)

Information Security Architect / Intelligence Analyst / Computer Scientist / Human Rights Activist / COMSEC / SIGINT / TSCM
RHODIUM GROUP

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