Carefully assess patients for pre-existing cardiac conditions, particularly congenital long QT syndrome (LQTS). A thorough family history is critical; LQTS often has a hereditary component. Inquire about sudden cardiac death or syncope in family members.
Genetic Testing and Electrocardiograms (ECGs)
Consider genetic testing for patients with a strong family history of LQTS or other arrhythmias. Regular ECG monitoring is recommended, especially during Prednisone treatment. Baseline ECGs before starting Prednisone allow for comparison and early detection of QT interval prolongation. Closely monitor the QT interval throughout the course of treatment. Frequency of monitoring depends on individual risk factors and clinical judgment but should be at least during initiation and any dose changes.
Other Predisposing Factors
Certain medications interact negatively with Prednisone, increasing the risk of QT prolongation. Document all medications the patient takes. Electrolyte imbalances, particularly hypokalemia and hypomagnesemia, significantly increase the risk. Regular electrolyte monitoring is therefore crucial, especially in patients with known risk factors such as diuretic use. Advanced age also increases susceptibility to Prednisone-induced QT prolongation; older patients require more vigilant monitoring.
Practical Recommendations
Educate patients about the symptoms of torsades de pointes (TdP), a life-threatening arrhythmia associated with QT prolongation. These include palpitations, dizziness, fainting. Emphasize the importance of immediately reporting any concerning symptoms. Consider consultation with a cardiologist for patients at high risk or those exhibiting signs of QT prolongation.
