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Potential borderline long QT
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Potential borderline long QT

  Hi,
      I am a 21 year old male, very physically active (college athlete, cross country and track). I have always had little palpitation related symptoms along with some occasional lightheadedness. About 3 months ago I got a little scared after feeling some of these palpitations while running (which occasionally happened before, but this time it scared me more) I decided to finally have these infrequent symptoms investigated. I have had resting EKG's, an echo, a stress test, a 24 hour Holter, have seen a cardiologist and an electrophysiologist, and am currently wearing a 30 day event monitor. . My echo showed no structural damage (DCM, HCM, valve abnormalities, etc), my 24 hour Holter just showed some isolated PACs and PVCs (16 PACs, 3 PVCs), my resting EKG's just showed RSr, my stress test was normal, the event monitor has helped us catch a couple PACs and PVCs I felt, along with a few brief sinus pauses while sleeping. My EP has looked at all my EKG's and said I don't show signs of Brugada, CPVT, ARVD, and he doesn't seem concerned with Long QT. However, I still am. Based on all this (palpitations during/post running, no fam. hist., no syncope, borderline QTc) what do you think about the possibility of me having LQT? Would you say it is a valid concern, or should I listen to my EP and not worry about it? Here are the EKG numbers:


404/445ms 73bpm, context: ER visit for palpitations (May ’12)
412/453ms, 71bpm, context: 24 hour Holter (April ’12)
412/448ms, 71bpm, context: visit to GP over palpitations, routine EKG (March’12) same visit, literally like 30 seconds later. They just ran it for about a minute and got a couple EKG strips.
414/427ms, 64bpm, context: visit to GP over palpitations, routine EKG (March’12)
380/398ms, 66bpm, context: ER visit for dehydration episode after long run in heat. (July ’11)
Avatar_dr_m_tn
Hello. Without having your full history, lab results and doing a physical exam is difficult to give you a specific recommendation. Generally speaking, the probability of having congenital long QT syndrome (LQTS) is usually based in the Schwartz score that incorporates the measured QTc interval and other clinical factors. This score was developed in 1985, with a last revision in 2011. Your resting QT is mildly prolonged (<460 msec) and from what you described, there is no family history of LQTS or sudden death. If you have never passed out at rest or during exercise, the analysis of your resting EKG and the QTc measurement post exercise during a treadmill stress test are of special interest. If the only positive finding is the mildly prolonged QTc, your probability of long QT is low. In conclusion, I would suggest writing to your doctor and asking specific questions (i.e. if there were other findings in your EKG or stress test). Good luck.
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Avatar_m_tn
  Something else I should mention is that I have been taking Lexapro 20mg daily since I was 12 years old (oddly, about the same time my palpitations started). My dad has long told me that he thinks that this could be causing my palpitation symptoms, as he is not a fan of being on medications. I have done some research and found that Lexpro at this dosage could actually increase the QT interval an average of 8 to 10ms. Given that I seem to be borderline do you think that maybe if I eventually got weened off the Lexapro I would see my QT and QTc intervals go down and therefore be more in the normal range? This is a study I found regarding this. http://www.magellanofaz.com/media/431014/citalopram%20escitalopram%20faq.pdf
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