Difference between revisions of "QT prolongation"

(Differential Diagnosis)
 
Line 38: Line 38:
 
***Jarvel/Lange-Nielsen
 
***Jarvel/Lange-Nielsen
 
****(+deafness; AR)
 
****(+deafness; AR)
***Romano-Ward synd
+
***Romano-Ward syndrome
****(nl hearing; AD)
+
****(normal hearing; AD)
 
***Sporadic
 
***Sporadic
 
***[[Mitral valve prolapse]]
 
***[[Mitral valve prolapse]]

Latest revision as of 04:30, 25 February 2020

Background

  • Prolonged ventricular repolarisation → increased risk of ventricular arrythmias
    • Males >440-450 ms
    • Females >500 ms
    • Rule of thumb: Normal QT interveal is less than half of preceding RR interval
  • QT interval is from the beginning of the Q wave to the end of the T wave
    • Rate dependent and should become proportionately shorter with increasing heart rate

Clinical Features

  • Most are asymptomatic
  • History may include:
  • Medication history may include QT prolonging medications

Differential Diagnosis

Drug List

Evaluation

Workup

  • ECG
  • CBC
  • Chem 10

Diagnosis

Acquired QT prolongation
  • ECG
    • On visual inspection, QT takes up more than half the R-R distance
    • Measure QT interval in lead II or V5-6
    • QTc = QT /√R-R

Management

Pause Dependent (precipitated by bradycardia)

Adrenergic Dependent (precipited by tachycardia)

Disposition

  • Consider admission, especially for QT >500 or if symptomatic
  • May require consultation for discontinuation of QT prolonging medications
  • Avoid prescribing medications that may contribute to prolonged QT

See Also

External Links

References