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Forum Name: Arrhythmias

Question: long qt syndrome


 michelletyrrell - Tue Sep 23, 2008 9:00 am

I AM CURRENTLY BEING INVESTIGATED FOR POSSIBLY CARRYING A LONG QT SYNDROME GENE, RESULTS WILL BE BACK IN 3 MONTHS BUT ONLY 20 % CHANCE OF PICKING IT UP. mY ECG SHOWS ABNORMAL REPOLIRISATION PATTERN AND QT INTERVAL OF 452MSECS. i HAVE HAS A COUPLE OF EPSODES OF VENTRICULAR TACHYCARDIA AND SINCE HAVE HAD LOOP RECOREDER IMPLNTED TO MONITOR THIS. i HAD NORMAL ANGIOGRAM IN 2003 WHEN i HAD SOME SHECT PAIN. i AM CONCERNED THAT i may need another angiogram as i NOW HAVE CONTINUED PAIN/BURNING IN LEFT ARM, PAIN/TINGLING IN LOWER GUMS AND JAWS ASWELL AS TINGLING IN HANDS AND LEGS AT TIMES. i FEEL LIGHTHEADED AT TIMES ASWELL AS FEELING WEAK, THESE SYMPTOMS OCCUR EVEN WHEN don't HAVE V-TACH. tHE CARDIOLOGIST SAID SHE NOT PUTTING ME THROUGH ANGIOGRAM WOULD BE MADNESS. i AHD STRESS TEST AND ECHO A COUPLE OF WEEKS AGO ALL WHICH FINE. sHE DOESNT THINK THESE SYMPTOMS APART FROM V-TACH ARE CARDIAC RELATED BUT HOW CAN SHE BE SURE? i AHD NORMAL HEART MRI IN jANUARY. whAT IS YOUR OPINION? tHE CARDIOLOGIST THINKS MY SUBCONSIOUS IS PLAYING TRICKS ON ME BUT i REALLY DO HAVE THESE SYMPTOMS AND AM EXTREMELY WORRIED THAT THEY ARE CARDIAC RELATED, MAYBE i DO NEED THE ANGIOGRAM?
 John Kenyon, CNA - Tue Sep 30, 2008 10:20 pm

User avatar Hello -

Is there a family history of Long Q-T or of sudden death? If not, you're not looking like a prime candidate, although I don't have enough information to use the scoring system that's used to help decide whether a person is likely to have it or not.

Since you've had some episodes of V-tach, do you know if they were the type known as torsade des pointes? The reason I ask is that this is specific to the diagnosis of long-QT as well as a number of other things.

I find it interesting that your doctor would have you perform a stress test but feels an angiogram would be "madness." The stress test is, well, more stressful than the angiogram, although the risks are about even. You did well on the stress test, so maybe that's why she doesn't want to go any further with the testing. The symptoms are worrisome, but I think it's important to either feel you can trust your doctor or else get a second opinion.

Coronary heart disease and hereditary long Q-T are not relatead (although a person with a compromised heart can develop prolonged Q-T interval temporarily). Your interval of 452 is right on the edge between normal and long.

I hope I've helped shed some light on this for you. Please follow up with us as needed, and if you have any other information to share, that would be great.
 michelletyrrell - Sat Oct 04, 2008 9:56 am

Thank You for your reply
My mothers ecg is similar to mine but does not show prolonged qt interval. She died of brain haemorrage and never suffered from any heart problems. There is no history of sudden death at a young age in the family.
My episode of v tach was a non sustained 10 beat run of monophoric vt of 232 beats per minute.My t-waves were inverted directly before and directly after the vt. I had a dynamic repolirisation change prior to onset of vt.
3 cardiologists have said there is no need for angiogram so I suppose I should trust them it is difficult though when I am getting the symptoms. Would the mri show any ischemia? Would the ecg readings from the reveal monitor show if any ischemia and or whether the symptoms should be angina related?
Thank You
 John Kenyon, CNA - Sat Oct 04, 2008 3:01 pm

User avatar You're very welcome.

I'll just make a few observations on your long Q-T diagnosis, based on the information you've supplied: generally this is a genetic trait, so if there's no family history, there may be some other, correctable cause for it. It also usually produces the distinctive torsade de pointes ("twisted points") complexes that are considered more ominous than regular, monomorphic V-tach. Finally, 232 bpm is a remarkably rapid rate for V-tach (not unheard of, but unusual to say the least). I'm wondering if it might not actually have been an atrial tachycardia with aberrant conduction, which looks almost identical to V-tach but upon close examination usually will disclose some p-waves hidden in the complexes. At the rate of 232 bpm it might be very hard to pick out the p-waves, though.

I don't mean to take issue with the diagnosis, but there are so many things about this particular instance which are fairly unusual that it makes me wonder if something else isn't going on. Hopefully you are followed for this on a regular basis, and recieve medication (often a beta blocker can help correct the interval and offer some protection against dangerous arrhythmias).

If you have no other signs or symptoms of coronary artery disease then the angiogram wouldn't be of much practical value, since it looks mainly at the structure of the heart and especially the condition of the arteries supplying it. However, yes, if there is any ischemia going on, the Reveal monitor would likely (not 100 per cent certainly, but very likely) show some indication of it.

Hopefully this is helpful. Best of luck to you.
 michelletyrrell - Thu Jan 29, 2009 12:28 pm

Hi
Just to update you on recent developments, the last time I saw cardiologist he suggested beta blockers, bisoprolol however I have not taken them as I am concerned re the side effects as my heart rate would be on the low side of normal. Howver he does not seem concerned with thisso should I try them?
On my loop recorder I have had 2 episodes of 9 beats of supra ventricular tachycardia
Is this of concern?
I am attending the cardiologist every 3 months. I still however am very worried even though they have resasurred me that my negative ep study was a good sign.
Wondering what you mean that you wonder whether something else is going on?
My ecg shows pr interval towards the lower limits at 122 milliseconds with no pre exicition. Qrs duaration and morophology was normal with slight prominence of the r waves in V1 and V2. Also non specific st segment sagging in the inferior leads in leads v4 to v6.
 John Kenyon, CNA - Fri Jan 30, 2009 11:55 am

User avatar Hi there -

Beta blocker drugs are very good prophylactic measure regarding Long Q-T, and the slowed pulse shouldn't be a problem. In fact, that sometimes is part of the solution to the problem.

The 9-beat run of SVT isn't a concern unless you feel these and they bother you. Again, beta blocking drugs should help prevent or minimize the occurrence of this.
In fact, if the SVT is conducted with abberrancy, it can look like V-tach, and would probably reach a higher rate. While an EP specialist should be able to recognize this if it's the case, it's something to consider also.

The "something else" I was thinking of was that the prolonged Q-T interval could be acquired due to some medication or even an electrolyte imbalance, such as often takes place in the setting of dehydration or a lack of potassium in the diet. These are things that presumably have been covered, but may not have been.

The EP study does sound reassuring, and this may indicate that the initial finding was due to some acquired, passing situation that's now corrected itself. Still, to err on the side of safety, I'd probably go with the beta blocker, at least a trial of a week or two, and if the side effects aren't significant, then keep it up. (If they are bothersome, which sometimes happens, please contact your doctor before discontinuing the drug, assuming you do start taking it).

Good luck to you.

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