This case report describes a 37-year-old male with recurrent ventricular tachycardia due to long QT syndrome. The patient experienced multiple episodes of sudden unconsciousness triggered by physical exertion. Electrocardiograms showed a prolonged QT interval over 500 milliseconds. The patient was treated with intravenous and oral amiodarone to revert episodes of ventricular tachycardia, as well as prescribed propranolol. He was advised to receive an implantable cardiac defibrillator but did not follow up. The long QT syndrome is a primary electrical disease characterized by an abnormally prolonged QT interval that can cause dangerous arrhythmias and sudden cardiac death if left untreated.

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