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Home | CCC | Long QT Syndrome

Long QT Syndrome

by Dr Chris Nickson, last update March 23, 2019

OVERVIEW

  • normal QT = < 440ms (two large squares) – prolonged QT > 450ms
  • produces prolonged ventricular repolarisation -> predisposes to malignant ventricular arrhythmias

CAUSES

  • drugs: amiodarone, TCA’s, many antibiotics, fluconazole, erythromycin, metoclopramide, quinidine, haloperidol, droperidol, methadone, ondansetron, SSRI’s
  • genetic: cardiac ion channel mutation (Na+, K+)
  • myocardial disease: MI, RF, 3rd degree HB, cardiomyopathy
  • electrolytes: low Ca2+, low K+, low Mg2+

ASSESSMENT

HISTORY

  • syncope
  • exercised induced syncope
  • cardiac arrest
  • FHx

EXAMINATION

  • may be normal

INVESTIGATIONS

  • ECG: QTc >440ms (11 small squares or T wave after half the R-R distance)
  • ECHO: structural heart disease

MANAGEMENT

  • beta-blockade
  • avoidance of increased sympathetic tone
  • cardiac pacing
  • treat cause
  • ICD

CCC 700 6

Critical Care

Compendium

…more CCC

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About Dr Chris Nickson

An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. @Twitter | INTENSIVE| SMACC

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