June 10, 2023

“Torsade de Pointes” is the term used to describe one type of heart rhythm irregularity (cardiac arrhythmia or dysrhytmia) that can arise as a side effect of chloroquine or hydroxychloroquine.
This abnormal rhythm can cause sudden death. To prevent this complication, the person who will use the drug needs to be evaluated before the drug is used and carefully monitored while on the drug.
When arrhythmia occurs, it is a medical emergency that needs immediate treatment with injectable medications like magnesium, atropine, or isoproterenol or with insertion of cardiac pacemaker. How does one know he or she has torsades de pontes?
Symptoms include dizziness because of reduced blood flow to the brain, nausea, palpitations, cold perspirations, chest pain, shortness of breath, and increased heart beats. Diagnosis of the arrhythmia is made with an electrocardiogram.
Torsades de Pointes may be inborn or acquired.
For acquired causes, the risk factors include abnormalities in blood electrolytes, like low potassium and low magnesium. Patients with heart disease, liver cirrhosis, kidney disease, or hypothyroidism are also at risk. This means that persons should have blood tests before starting the drug for risk stratification.
Hydroxychloroquine and chloroquine can interact with more than 300 drugs. They induce arrhythmia when combined with other medicines that prolong QT interval like azithromycin.
The U.S. Food and Drugs Authority has issued an emergency use authorization which allows the temporary use of chloroquine and hydroxychloroquine for treatment of viral disease in certain hospitalized adolescent and adult patients during the Covid-19 pandemic but it does not imply that any person can just self-medicate with it. These drugs have not yet been shown to be safe and effective for treating or preventing the Covid-19. Their use is authorized only for experimental or research studies at this time.
There are already pieces of evidence that the Covid-19 can affect persons of all ages while recovery can occur among the elders and the immune-compromised and signs/symptoms can vary from mild to severe. It is not always a fatal infection as evidenced by the number of recovered cases. Prevention is still the key. A vaccine cannot be rushed because several questions have to be answered before a vaccine for human use may be marketed, like: Is the vaccine effective in preventing the viral disease? If it is effective, is it safe? What dose of the vaccine elicits an adequate level of anti-bodies that can protect from the virus? How often should it be given? Do the anti-bodies confer lifetime immunity? Trials cannot be done right away on human beings, so the vaccines should be done on other animals first, like on monkeys.
It is still advisable to remember that lifting or relaxation of quarantine rules do not mean that SARS-coV-2, the virus that causes the Covid-19 has gone away. The threat is still there.
We can be the source of infection and we can be infected by other persons. Prudence and basic preventive measures remain the best defense we have at the moment.Wear your face masks, wash your hands, sanitize, maintain social distancing, eat and sleep well, and comply with the restrictions.

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