H52 A literature review on electrocardiogram (ECG) recording in patients with huntington’s disease on antipsychotic medication


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Abstract

BackgroundHuntington’s disease (HD) is a heritable neurodegenerative disorder, with cardiac disease involved as one main cause of death.1,2 Patients on antipsychotics had a dose-related increased risk of sudden cardiac death on cohort study.3 These results suggest caution is indicated in using medications that may have additive cardiac risk.4 It has been advised that ECG monitoring should be done during admission and at least when multiple Psychotropic, and other predisposing factors for QT prolongation are present at admission.5AimTo investigate the literature for studies concerned monitoring ECG in patients with HD on antipsychotic medication.MethodsA review of literature was conducted through E-Library of Greater Manchester Mental Health NHS Foundation Trust (Library and Knowledge Services).3 databases were searched with the purpose of identifying key articles in English language from 1974 to 2018.For EMBASE and PsycINFO databases, the search terms used were ‘ECG/Electrocardiogram’, ‘Huntington’s disease’, ‘Antipsychotics/neuroleptic agent’. For Medline database, the search keywords included ‘ELECTROCARDIOGRAPHY/AND ‘HUNTINGTON DISEASE’/OR (Huntington*) AND ‘ANTIPSYCHOTIC AGENTS’/).The search strategy also included manual search of personally selected literature. This resulted in very limited relevant studies.Animal studies were excluded.ResultsEMBASE produced 10 results but the majority of these were irrelevant. Only one RCT study considered as relevant.PsycINFO did not generate any results with the use of the above search terms. However, the search terms were modified as ‘Antipsychotics/and Huntington’s disease’ and this resulted in 4 results but none of these were relevant to research subject.Medline database generated only 1 study which considered as irrelevant.DiscussionThere are currently no specific standards for monitoring ECGs in patients on antipsychotics and/or patients at high risk of developing heart problems. The trust guidelines for physical assessment for patients states that an ECG should be undertaken on admission for patients who currently taking medication such as Antipsychotics. The RCPsych Consensus statement on high-dose antipsychotic medication and NICE guidance also similarly recommends ECG recording.Conclusion and recommendationThere is very little evidence in the literature investigate the monitoring of ECG in HD’s patients on antipsychotics. This require further exploration in the future. It’s important to monitor ECG at early stage in HD’s patients even before starting them on antipsychotics. I suggest to monitor ECGs at regular intervals in outpatients and inpatients settings. We should also seek advice from Cardiology team if there is any concern about the ECG’s findings. This will help in detecting early signs of cardiac problem and prevent further deterioration in the cardiac function. Cardiac distress can compromise the well-being and quality of life of HD’s patients.References. Andrich J, Schmitz T, Saft C,Postert T, Kraus P, Epplen JT, Przuntek H, Agelink MW. Autonomic nervous system function in Huntington’s disease. Journal of Neurology, Neurosurgery & Psychiatry2002;72(6):726–731.. Abildtrupa M, Shattockb M. Cardiac dysautonomia in huntington’s disease. Journal of Huntington’s Disease2(2013):251–261.. Ray WA, Cecilia P, Chung CP, Murray KT, Hall K, Stein CM. Atypical antipsychotic drugs and the risk of sudden cardiac death. The New England journal of medicine (N Engl J Med)2009January 15;360(3):225–235.. Stephen C, Hersch S, Rosas H. Huntington’s disease and the heart: Electrocardiogram abnormalities suggest cardiac involvement (P5.294) April 06, 2015;84(14 Supplement):April 22, 2015.. Girardin F, Sztajzel J. Cardiac adverse reactions associated with psychotropic drugs. Dialogues Clin Neurosci2007March;9(1):92–95.

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