An algorithm for managing QT prolongation in coronavirus disease 2019 (COVID-19) patients treated with either chloroquine or hydroxychloroquine in conjunction with azithromycin: Possible benefits of intravenous lidocaine

Figure 1. Chest computed tomography of patient on March 16, 2020, showing extensive right lung infiltrates.

Figure 2. A: Electrocardiogram (ECG) showing prolonged QTc of 620 ms using Bazett’s formula after 1 dose of hydroxychloroquine in a patient on azithromycin. B: ECG 30 minutes after administration of 100 mg intravenous (IV) lidocaine with reduction of QTc to 550 ms.

Figure 3. Flow chart to manage effects on QTc with chloroquine, hydroxychloroquine with azithromycin. bpm = beats per minute; Dob = dobutamine; ECG = electrocardiogram; Epi = epinephrine; IV = intravenous; K = serum potassium; LQTS = long QT syndrome; Mg = serum magnesium; NE = norepinephrine; TdP = torsades de pointes.