Long QT interval on EKG, need advice!!

[someonehelpme916]

I am a 26 year old female, 5'1 and weigh 97 lbs (used to weigh 105 but have lost a lot of weight the past couple of months!!). Over the past few months I've been to the ER quite a few times, twice just this past week! I had an episode about a week ago (8/8) while shopping where I felt as if I was going to faint. I was fighting to stay conscious and had a VERY fast heart rate (160bpm), shakiness, nausea, and broke out in a rash on my upper left arm and chest all within a matter of minutes. I rushed straight to the ER which thankfully was right across the street. They gave me an EKG and drew blood for labs. I was told I had a prolonged QT. I am very scared... I had an EKG back in April that came out normal and an EKG just yesterday (8/13/12) as I had another episode but was told my results were normal? Was this a false positive? Can these show up positive on one test and be negative on another? I heard this was an inherited condition or drug induced, I have no sudden deaths in my family that I am aware of, although my Mom is adopted so we don't know too much about this. I also was not on any medications that could have shown this result on my EKG. After telling me that I had a abnormal EKG they sent me home and just said it was panic/anxiety but am worried its something more.

My results (from 8/8/12) are as follows;

HR 98
PR 187
QRSD 86
QT 392
QTc 501

AXIS
----
P 63
QRS 53
T 49

Then it says: abnormal ECG: Sinus rhythm, prolonged QT

My test from yesterday (8/13/12) says

HR 83
PR 165
QRSD 88
QT 397
QTc 467

AXIS
-----
P 10
QRS 67
T 41

Then it says: Sinus rhythm, Normal ECG

I am confused. I don't know how to read these tests very well. Despite my most recent EKG being normal I am still having the same symptoms I had with the abnormal EKG. I have a racing heart multiple times a day, arm weakness, faint feeling, stabbing chest pains that come and go and generally just do not feel well. My labs recent labs showed low vitamin D, could this cause prolonged qt? My WBC, HGB, HCT, MCV, MCH, MCHC are also ALWAYS in low range. I've had my thyroid tested MANY times to no avail. I am seeing a cardiologist soon, are there any special tests/questions I should ask? Do my EKG results point to any particular heart condition (besides LQTS)? I am very worried and scared!! Thank you in advance to anyone who replies or has any advice!

[birnam]

I just realized how confusing my comment might have been. To clarify I just meant the Dr meant there are many things that can affect the outcome of the QTc, and that it's easily altered and needs careful calculating.

[birnam]

Hopefully this will put your mind at ease, but I just had two different ECG's performed. One with a heart rate of 88, and one with a heart rate of 130, and both had a QT interval of 380-390, but my Qtc was 440-480, and luck would have it I saw an electrocardiologist 2 days ago, and he told me not to even bother with the QTc cause it's all based on calculations and varies with heart rate. What I gathered from our meeting is so long as the QT is normal it's fine. QTc, is based on calculations and has to do with what it is assumed your QT  # would be at a heart rate of 60 given what your QT score is at your heart rate during the test and RR numbers.

[spade22]

Sorry for typos - autocorrection from my iPad.

To answer your other question, I haven't heard of a vitamin D deficiency causing prolonged QTc.

[spade22]

Its important you see an electrophysiologist (EP) rather than a cardiologist.  As EP deals with electrical issues of the heart rather than heart plumbing issues (blockages etc) and what you have is an electrical issue.

QTc values really need to be measured/calculated  by hand by an experienced EP  and the computer-generated values tend to be inaccurate.  Get copies of your EKGs to take to your appointment and have the dr measure them - it's possible you dont have a prolonged QTc a all.   Based on your other  symptoms, you will likely need to wear a Holter or event monitor.  If you do indeed have a prolonged QTc and any concerning arrythimias  are captured then your dr may want you to do a stress test (exercise on treadmill for a short time while monitoring your EKG and BP).

Also, as others have mentioned, a prolonged QTc can be caused by electrolyte imbalances and some people have a borderline high QTc but dint actually have LQTS.  I know its hard, but try not to worry at this point because there are a lot of different things that could be going on.  

Following up with a specialist is the right thing to do.  Also, keep in mind that if you do happen to be one of the rare cases of LQTS, the syndrome is highly treatable!

BTW did the ER dr suggest you avoid QTc prolonging medications while you wait for your appointment?    Qtdrugs.org provides an up-to-date list of drugs (including OTC medications such as decongestants) that should be avoided by those with a prolonger QTc.  If there are medications on the list you need to take between now and your appointment, call the dr and ask about it.

[MichelleP_3811]

It is good to hear you are going to see a cardiologist.  It would be good to get a full workup if you haven't already.  That said, it could be that some of your issues are due to causes other then any structural heart problems.  It sounds like your electrolytes are a bit low.  This can cause the heart to act up.  You also are below normal in weight.  If you have a normal diet eating fruits, vegetables, grains, dairy and lean meat and are still struggling with your electrolytes you may want try adding some supplements to your diet to see if that helps.  If you are eating normal amounts of food and the weight loss is sudden and unexpected without cause then I might get checked to ensure your body is not having an issue absorbing the nutrients for some reason or isn't fighting a virus which can sometimes affect the heart.  For whatever reason you are having issues to be determined it is important that you maintain proper hydration and sodium levels which could otherwise lead to low blood pressure and cause your issues with near passing out.  So until you get this all figured out I suggest trying to ramp up your intake of water and maybe a few salty snacks if you don't have high bp.  It will likely help you feel much better.  Good luck with the cardiologist and maybe also go see a GP to get tested to see if you have a virus that may be affecting you and what supplements you should maybe take to get your body back in balance.  Take care and keep us posted on how you are doing.

[Mom2four85]

I've had long qt's but it's due to my problems that weren't found until I was in my 40's.

What I suggest is to go to a cardiologist outside an emergency setting for a complete cardiac workup and have your electrolytes;  esp potassim & magnesium drawn again.

it may be nothing to worry over;  it may just be a low potassium and can be treated easily but you def should get a workup just to be safe

[someonehelpme916]

I also forgot to mention I did have low potassium at 3.2 a couple of months ago. I read that prolonged qt can be from Hypokalaemia. My potassium was 3.5 when I had my EKG on 8/8, which is normal but just thought I would mention it!