16-year old male presenting with syncope. Describe and interpret his ECG.
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
- Markedly peaked T waves in V2-6.
- Extremely short QT interval (~240 ms).
In a patient presenting with syncope, this ECG pattern is very suspicious for the short QT syndrome.
Short QT Syndrome
- This is a recently-described arrhythmogenic condition associated with paroxysmal atrial and ventricular fibrillation.
- The hallmark is a significantly shortened QT interval (at least < 360 ms, often < 330 ms) with associated T-wave peaking.
- SQTS is a genetically-inherited cardiac channelopathy on the same spectrum as other familial arrhythmogenic diseases such as Long QT Syndrome (LQTS), Brugada Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT).
When to Suspect SQTS
- Any patient with a QT interval < 330 ms.
- QT interval < 360 ms and convincing symptoms (syncope, cardiac arrest) or family history.