Short QT

Background

• Clinically important due to potential to cause atrial and ventricular tachycardias, syncope, and sudden cardiac arrest

Etiology

• Congenital short QT syndrome (rare, but important cause of sudden cardiac death)
• Hypercalcemia
• Hyperkalemia
• Digoxin toxicity
• Acidosis
• SIRS
• ACS
• Increased vagal tone

Clinical features

• Syncope
• Cardiac arrest
• Palpitations
• ECG findings:
  • QTc < 360 (males) or <370 (females)
  • In congenital short QT, also have:
    • Lack of normal QT changes with HR
    • Peaked T waves (especially in precordial leads)
    • Short or absent ST segments
    • +/- early repolarization

Management

• Evaluate for and treat underlying causes
• Congenital short QT: refer to cardiology, may need ICD

References

• Merino JL and Reviriego. Short QT Syndrome: An article from the E-Journal of the ESC Council for Cardiology Practice. Vol. 9, N° 2 - 17 Sep 2010. http://www.escardio.org/Guidelines-&-Education/Journals-and-publications/ESC-journals-family/E-journal-of-Cardiology-Practice/Volume-9/Short-QT-Syndrome.