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Prolonged QT; LQTS
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Prolonged QT; LQTS

6379517?1290361614
I've been reading about LQTS and prolonged qt's - one of the things that keep popping up is the prolonged QT and syncope (fainting) which is one of the things that I read when I first started back in June 2009.  I've suffered syncope since age 9 and never had a dr say anything was wrong until June 2009.

I got my report from the hospital finally and it says the usual things - low voltage QRS that no one can explain - that has been on all but 1 of my ekg's.  

My other testing I had shows Cardiomegaly of the heart; vascular crowding and frequent multifocal pvc's; which I didn't know I had multifocal pvc's before I got the results.  Also, the thoracic part of my spine shows degeneration for some reason - no injuries to that area, but I found it weird that showed up when I started having all of my cardiac related problems.

Vent Rate:         85  
PR                   146
QRSD               102
QT/QTc             398/473  
P/QRS/T Axes   61/56/36
Frequent PVC's
Low voltage QRS
Prolonged QT

I've looked over all my other ekg's compared them; enlarged them etc - I can't see where it shows prolonged QT's - this ekg looks just like all my other ekg's I've had.  Can anyone point me to the part it where actually shows on my 7/26/2009 EKG multifocal pvc's or prolonged QT? I just don't see it - maybe they didn't include that part - they only sent me 1 strip for 11 hours of being there.

I did my LQTS point system (http://emedicine.medscape.com/article/157826-diagnosis), 460-469 would be 2 pts >480 3pts but I'm between 2 & 3 pts, plus syncope or TDP would be 2 pts = 4pts, which would mean I had a high probability of LQTS but the hospital and dr's didn't think anything of it.

Maybe this means nothing or will mean something to a new EP since polymorphic VT was confirmed?  Maybe I'm way off base or finally found the missing piece of the puzzle? LQTS, HCM...what else could it be....

if the picture doesn't show up, I posted it in my profile pictures also
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1124887_tn?1313758491
It's a bit strange that no one answered this. I can give it a try, though..

The PVCs in your EKG (that I'm really not supposed to interpret, but since we've discussed this for some time now I suppose it's ok) shows ventricular trigeminy with (from what I can see) monomorphic PVCs originating in the RV. The T waves seem normal.

Your QT time is slightly prolonged in this EKG, but I remember some EKG's of you where the QT time actually was below normal limits (as far as I know that's uncommon with LQTS because it's a genetic disorder). On the other EKG's, your QT time is normal. The QT time (which is the duration of the systolic phase of the heart, in other words, the heartbeat duration, if that made any sense) can vary greatly through the day, depending on activity, potassium/calcium levels, medications, etc.

If you've suffered syncope since you were 9, you should mention it to your new EP and bring this EKG, but I think your doctors would have suspected / diagnosed you with LQTS if you had that, after all your tests. LQTS can't explain all your PVCs, but PVCs are less benign with LQTS, because prolonged repolarization increases the chance that a PVC can occur during the vulnerable phase (R on T phenomenon) which can trigger Torsades, as you know.

You can have prolonged QT without having LQTS. Several conditions can cause prolonged QT, including:

Hypokalemia
Hypocalcemia
Antiarrhythmic drugs
Anti-anxiety drugs
(I'll stop listing the drugs, you can find the entire list at torsades.org or qtdrugs.org)
Thyroid disturbances

By the way, the "QTc formula" is a mathematical approach, and not necessarily correct, if you use another formula that is commonly used, your QT in this EKG is 446 ms. Anyway, ask your new EP. I can't say yes or no to this, it's something to consider, but as your QT usually is normal and the other doctors ruled it out, it's not very likely I think.
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1124887_tn?1313758491
It's a bit strange that no one answered this. I can give it a try, though..

The PVCs in your EKG (that I'm really not supposed to interpret, but since we've discussed this for some time now I suppose it's ok) shows ventricular trigeminy with (from what I can see) monomorphic PVCs originating in the RV. The T waves seem normal.

Your QT time is slightly prolonged in this EKG, but I remember some EKG's of you where the QT time actually was below normal limits (as far as I know that's uncommon with LQTS because it's a genetic disorder). On the other EKG's, your QT time is normal. The QT time (which is the duration of the systolic phase of the heart, in other words, the heartbeat duration, if that made any sense) can vary greatly through the day, depending on activity, potassium/calcium levels, medications, etc.

If you've suffered syncope since you were 9, you should mention it to your new EP and bring this EKG, but I think your doctors would have suspected / diagnosed you with LQTS if you had that, after all your tests. LQTS can't explain all your PVCs, but PVCs are less benign with LQTS, because prolonged repolarization increases the chance that a PVC can occur during the vulnerable phase (R on T phenomenon) which can trigger Torsades, as you know.

You can have prolonged QT without having LQTS. Several conditions can cause prolonged QT, including:

Hypokalemia
Hypocalcemia
Antiarrhythmic drugs
Anti-anxiety drugs
(I'll stop listing the drugs, you can find the entire list at torsades.org or qtdrugs.org)
Thyroid disturbances

By the way, the "QTc formula" is a mathematical approach, and not necessarily correct, if you use another formula that is commonly used, your QT in this EKG is 446 ms. Anyway, ask your new EP. I can't say yes or no to this, it's something to consider, but as your QT usually is normal and the other doctors ruled it out, it's not very likely I think.
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1124887_tn?1313758491
The low voltage QRS:

Possible causes:
Females have, in general, lower voltages than men, because 1) your heart muscle is somewhat smaller, and 2) sometimes the breasts can reduce conduction between the leads (which I think can be eliminated by correct lead placement).
Decreased mass / dilation of the heart.
Overweight, or from other causes long distance between chest wall and heart.
Increasing age.

In my case, it's the opposite. I have abnormal high voltage, (EKG indicates LVH) but the cardiologist said that's a normal variant in young, somewhat nervous men. I do not have LVH.
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967168_tn?1343732745
ahhh thanks =) pretty much what I've read so far. [waves a magic wand] I absolve you of all MH restrictions! hah!....like anyone else would even try to interpret my mess; dr's don't even know ...I find it weird I have I have long and short qt sometimes within a short duration - again another formula that has no 'set rules" and can be normal one way but abnormal with another formula...

"The diagnosis of LQTS is not easy since 2.5% of the healthy population have prolonged QT interval, and 10–15% of LQTS patients have a normal QT interval." Not sure how accurate that is, but I think my problem is low calcium - 8.0 - 8.2 around surgery dates but at other times its been 9.1 - 10.0

Low voltage QRS makes sense now - I have a smaller heart; my heart mass is decreased at 105g [normal 141g] being larger breasted and getting older; it's been on all my ekg's no matter how much I've weighed - low or higher weights so that may explain it.

back to the drawing board....:P
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967168_tn?1343732745
I posted in the ask a doctor forum also (http://www.medhelp.org/posts/Heart-Disease/Prolonged-QT/show/1398670) - some of the things I've been told agrees with and he hit on some thing I don't want to think about, but have been told to look at...heart problems even lethal ones don't scare me as much as cancer does - I'm weird I guess.

I don't get anxious or stress normally over arrhythmia's but even thinking about my mother & father both having cancer scares the &$#@ out of me...
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1124887_tn?1313758491
I read the answer there and I got somewhat confused.

Every malignant cause of skeletal degeneration have something in common: Hypercalcemia, due to calcium release to the blood. There is a blood test that more or less rules this out, PTH-RP (parathyreoidea hormone reactive protein). If your calcium is low, I wouldn't pay attention to this, but again, your doctor should decide.

I've been there, because I had slight hypercalcemia, but in my case, the explaination was vitamin D overdosage (I was trying to live sooo healthy..)

You should probably have posted some of your other EKGs in the post, in most of them, your QT time is normal. The TdP is somewhat concerning, though, but it may be a consequence of several R on T PVCs. I really don't know.. :(

I think you have enough to worry about concerning the heart. Don't be afraid of cancer too. The cardiologists are a bit too eager to suggest non-cardiac causes. When I once told a cardiologist I had slight chest pain, he suggested to do CT aorta and gastroscopy, and look for hormone producing tumors. I really don't understand why.


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967168_tn?1343732745
oh, I was worried about cancer long before my heart problems cropped up, I wish I could get rid of the worry as easy as heart - I might need a therapist over all of this :(

My mother developed breast cancer at 38 and died at 52, 5 of 6 of her sisters has had it and it runs rampant on her side of the family.  My dad had Hodgkins Lymphoma, but I'm not sure if it runs in families or not...but with my odds it does!

still the cancer thing scares me - I've been told by another doctor recently my lab results could be from cancer (that's for another forum :P) When I was 23, I had a neoplasm? cell removed from my cervix they caught [I'll have to find the name of it grrr my brain is useless sometimes] that was level 2; no recurrences but I havent been to the GYN in 5 years...

probably a bigger worry is the baseball sized lump in my left underarm that the doctor looked at in 2004 had tested and they couldn't figure out what it was; so I'm going to have them look at it again - it's not the size it was but comes and goes with the swelling; which leads me to think lymph nodes.

I'm going in Janand get this trainwreck of a body figured out and fixed before my heart decides I really can't handle all the stress....
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Avatar_f_tn
Hi Lisa,
Everything I will be telling you is stuff I have learned as a LQTS patient, I have no medical background. You need to make an appointment with an Electrophsiologist experienced with Long QT Syndrome soon.

QT intervals can change from ECG to ECG, they can even change heart beat to heart beat. People with genetic LQTS can have large variations in their ECGs, ranging from normal, even below normal, to very very long. The fact that you are having PVCs in a pattern, have a prolonged QT and have had multi-focal PVCs in the past means that you can be susceptible to Torsades de Pointe, this is a very fast rhythm that can degenerate into VF.

Most doctors and even Cardiologists are famous for overlooking LQTS (there are several studies available on the internet - just google). I had a long history of fainting, like you, since about the age of 11, sudden deaths in family members and still doctors didn't pay attention to our QT intervals.

It was through my own research on the internet that lead me to the SADS foundation that helped me find a doctor in my area who was capable of making the diagnosis. My oldest son had a cardiac arrest and I wasn't stopping until I found an answer to why this happened to him. My daughter's twin sister died from this years before but we never knew why at the time.

There are causes of acquired LQTS than can be corrected (electrolyte imbalances, etc) or from certain medications (www.qtdrugs.org). But it needs to be checked out either way.

I do have contacts with world-leading specialists from Europe and one from the US who are willing to read ECGs by email. I have sent mine to them in the past and they are quick to reply. Just send me a private message and I will give you their emails if you like.

Please check this out, LQTS is deadly when not treated, but if treated, most people lead normal, long lives.

Take care,
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967168_tn?1343732745
I'm going to send you a PM, but wanted to say thanks for the reply and info.  

During my ablation, my EP was shocked beacuse he I went into long runs of polymorphic Vt; he did not have any clue I had multi focal pvc's - the hospital would not release these records (long long story) but when he found these he did a cath, ct's, and MRI to see if it was ARVD - testing was inconclusive.  

So I've been in search of answers for 16 months now and been through a few doctors trying to find out what's causing my problems.  Since my EP touched on genetic and said he thought it was genetic; I started researching - process of elimination - ARVD negative, I talked to Dr. Ramon Brugada twice and he looked over all of my paperwork and said negative for Brugada.  

I'm still going down my list and putting everything together for a new doctor since I have new insurance - hopefully I can find some answers soon =)
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967168_tn?1343732745
sorry I forgot to add - they did implant a pacemaker/icd just in case anything happened again since I had fainted for so long and found the polymorphic VT during my EPS
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Avatar_f_tn
I sent you a PM. Yes, I do have an ICD and take beta blockers.
Take care,
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