The nurse is caring for a patient with schizophrenia who has bacterial endocarditis secondary to intravenous drug use. The patient’s antipsychotic medication is changed from risperidone to clozapine. Within days, the patient develops a serious cardiac arrhythmia. The nurse attributes the patient’s arrhythmia to which cause?

Question

The nurse is caring for a patient with schizophrenia who has bacterial endocarditis secondary to intravenous drug use.  The patient&rsquo;s antipsychotic medication is changed from risperidone to clozapine.  Within days, the patient develops a serious cardiac arrhythmia.  The nurse attributes the patient&rsquo;s arrhythmia to which cause?

Accepted Answer

Prolongation of the QT interval. The QT interval on an EKG is the period of depolarization and repolarization of the ventricles.  Significant prolongation of this interval can result in the development of serious cardiac arrhythmias.  There are many drugs which prolong the QT interval as a side effect and these drugs should be avoided in patients with an already genetically long QT interval.  This patient taking clozapine likely prolonged his QT interval and resulted in the development of cardiac arrhythmia.  Tricuspid valve vegetations are commonly seen in right sided bacterial endocarditis, but they do not predispose to cardiac arrhythmia.  Acute pericarditis can result in EKG changes but usually not frank arrhythmia.  Irritation of the myocardium is a common cause of more benign supraventricular tachycardias or occasionally premature ventricular contractions (PVCs), but rarely is the cause of more serious arrhythmias.

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