qt syndrome

1. Case Report on
Recurrent Ventricular Tachycardia
Due to Long QT Syndrome
Rambabu Singh, Kshitiz Nath,
Archana
JAPI Dec 2016

2. • The long QT syndrome (LQTS) is a primary
electrical disease which is characterized by
prolongation of the disordered ventricular
repolarization of the corrected QT on the surface
ECG.
• Normal QTc ranges — Overall, the average QTc in
healthy persons after puberty is 420±20
milliseconds

3. Copyrights apply
QTc = QT interval ÷ √RR interval (in sec)

4. Other ECG characteristics
• The T waves of patients with congenital LQTS
are frequently abnormal with a biphasic
contour or a prominent notched component
(particularly in LQT2). However, this finding is
fairly insensitive, and the absence of an
abnormal T wave morphology does not
exclude patients from having congenital

5. • Various mutations in at least seven genes
coding for cardiac ion channels.
• 7 known type of inherited LQTS , most
comman are LQTS 1-3

6. Copyrights apply

7. c/o
• Syncope
• seizure like activity
• Ventricular arrhythmias
• sudden cardiac death.

8. Case Report
• Centre – Dept of Medicine,MLB Medical college
Jhashi UP
• 37 years old male
resident of Jhansi, who suffered from
sudden onset unconsciousness for 4-5
minutes.
• This episode was not associated
with any abnormal body movements,
frothing from mouth, any urinary or
fecal incontinence, or limb weakness

9. Past H/o
• 4-5 similar episodes
• were precipitated on
doing some heavy work.
• Vitals
• BP was
100/70 mm Hg, PR -98/min
• o/e Chest has b/l Crepitations

10. • Next day 8 am , pt become unconcious
suddenly , ECG shoed VT with rate 360/min
• Urgent DC shock of 150 J was given
• and the VT reverted.

11. Copyrights apply

12. • Patient again
• developed VT at 11 am, 11:45 am, 1:30
• pm and 3:00 pm; every time he was
• reverted by giving DC shock of 150 to
• 250 J and he was started on injection
• Amiodarone 150 mg IV stat over 10 min
• and then 360 mg over 6 hours and was
• further maintained on oral treatment

13. ECG has prolonged QT interval with corrected
• QTc of about 500-510 msec and notched
T waves

14. • Pa t i e n t wa s d i s c h a r g e d o n
propranolol and was advised for ICD
(Implantable cardiac defibrillator)
implantation.
• On subsequent followup, patient did not
undergo ICD insertion and remained symptom
free for 2 years, then again developed similar
episodes

15. Discussion
• Amoung untreated patients mortality is high
20% mortality in the first year after the initial
syncope and approximately 50% within 10
years

16. Testing in suspected cases
• In suspected cases, bicycle or trademill testing
• Holter monitering
• Provocative testing

17. Diagnosis
The points are added to
calculate the LQTS
diagnostic score
("Schwartz Score").
probability of having
LQTS
●Low – ≤1 point
●Intermediate – 1.5 to 3
points
●High – ≥3.5 points

18. Treatment
• Beta blocker
• Propanolol
• Nadolol
• ICD ( Implantable cardiac defibrillator)
For LQT3 , Mexiletine Class Ib Antiarrythmic use
along with Beta blocker is also considered