Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Cardiac contractility modulation wikipedia , lookup
Coronary artery disease wikipedia , lookup
Myocardial infarction wikipedia , lookup
DiGeorge syndrome wikipedia , lookup
Williams syndrome wikipedia , lookup
Turner syndrome wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Marfan syndrome wikipedia , lookup
Down syndrome wikipedia , lookup
Antihypertensive drug wikipedia , lookup
Ventricular fibrillation wikipedia , lookup
Management of acute coronary syndrome wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
LONG QT SYNDROME Katie DePlatchett, M.D. AM Report April 7, 2010 LONG QT SYNDROME (LQTS) QT interval = beginning of the QRS to the end of the T wave duration of activation and recovery of the ventricular myocardium. Bazett formula: QT/ square root of RR > 440 msecs in men > 460 msecs in women LONG QT SYNDROME (LQTS) Disease of the ion channels Prolongation of the action potential Early after depolarization* Increased sympathetic activity Imbalance in sympathetic innervation of heart ACTION POTENTIAL ACQUIRED Metabolic (HypoK, HypoMg, HypoCal, Anorexia, Hypothyroidism) Medications Antiarrhythmics (sotalol, amiodarone, etc) Antibiotics (Macrolides, Fluoroquinolones) Psychotropic (Haldol, TCAs, Thioridazine) SSRIs, Risperidone, Methadone, Droperidol, protease inhibitors ACQUIRED Myocardial Ischemia or Infarction Intracranial disease Hypothermia HIV CONGENITAL h/o syncope, family h/o SCD, deafness 7 genetic defects Important for identifying arrhythmia triggers LQT1 = exercise-related LQT2 = auditory stimuli LQT3 = at rest or sleep; no benefit from BB Most cases discovered after syncope or arrest TREATMENT Primary Prevention Beta blockers Avoidance of strenuous activity/sports Left cardiac sympathetic denervation Secondary Prevention Beta blockers ICD Avoidance of QT prolonging agents BACK TO OUR PATIENT… Discharge with life vest & beta blocker Repeat Echocardiogrm = normal EF Genetic testing: LQT1 + LQT9 mutations LQT1 = EXERCISE RELATED!!! No more novice marathon training. s/p ICD placement No Family History of SCD REFERENCES Schwartz, PJ. The long QT syndrome. Curr Probl Cardiol 1997; 22:297. Zipes, DP, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias & Prevention of SCD. J. Am Coll Cardiol 2006; 48; 1064. Priori, SG, et al. Association of long QT syndrome loci and cardiac events among patients treated with beta-blockers. JAMA 2004; 292;1341. UpToDate