Long qt? Scared

[Star3851]

I recently went to an urgent care facility because of a panic attack, and my QT (assuming QTc, as the computer read it) was bordlerine prolong qt. I believe it was 440ms. I then went to several er visits and my GP because of chest pain which they said was due to anxiety. I had 3 more EKG's, all of which docs said had normal QT values. Being terrified still beacause of chest pains, I went to see a Cardiologist who was also an Electrophysiologist. He measured my QT (again, assuming QTc) as 465 ms. My stress test and echo were fine he said. He said I have nothing to worry about, but is going to order a genetic test for me peace of mind even thoguh he doesn't think itis necessary. . He said that he sees healthy people with this reading all of the time. The other cardiologist in the practice said he would not blink if he saw this on an EKG of his daughters. I am still terrified that I somehow have this disease. I insisted they put me on a beta blocker while we wait for the genetic test, but am terrified I could have LQTS 3 and die in my sleep. I have no history of fainting (1 dizzy spell/vertigo at 22 when I was student teaching, just having lunch, and then vomited). My family had no history of heart problems or sudden death. Do you really see lots of normal patients with a QT of 465? THat seems so high to me yet the cardiologists are unconcerned. Please shed any light on this that you can. I have read some very bad things on online forums where people don't discover they have this disease until later in life and they had normal EKGs. If the genetic test is negative am I in the clear?  I am 26 years old. Any advice would be grealty appreciated.

[helyanna]

My  QTcs from 2010 to 2013:

438, 444(afib), 407(afib),461(afib), 432(afib), 422(afib), 449(afib), 448, 410, 428, 423, 445, 430, 421(afib), 428(afib), 427, 422, 460,452, 454.

When I asked why my QTc was as high as 460, the cardiologist was ashtonished and said that it is normal. OK, it is normal.

I cannot take certain drugs which can prolong QT. I avoid them, but do not have long QT syndrome because my QTCs are normal. A genetic test has not been done.

When I was younger, I often had tachycardia, possibly sinus tachycardia. During this year I have got a new rhythm disorder, SVT episodes.

[CheyannePumpkinhead]

Can have acquired Long-QT, like I have, when taking certain medicine like benedryl or pepcid my QT is prolonged. I believe a certain percentage of people with Long QT do not fall into the genetic categories. I was patient at Strong Hospital in Rochester, NY and they sent me to Cleveland Clinic in OH and I now wear 3 year Internal Loop Recorder(heart monitor) and avoid Long QT drugs.

[Star3851]

I ended up getting the genetic test done.. it came back negative, and the doctor says my qt values are fine, so I don't believe that I have long qt. I saw Dr. Spencer Rosero in Rochester, NY who is a specialist in long qt. When he measured my qts by hand, the highest he found is 440 for qtc. He was sure I didn't have it and he has never been wrong. Nevertheless, I ended up getting the genetic test.. low and behold it turned out negative! If you were low on potassium it definitely could have caused the high qtc reading. Since your other readings were all normal, I wouldn't be concerned. Have you seen an electrophysilogist? If not that's what I would do.

[chuck86]

If you could shed any light on your progress thus far it would be greatly appreciated. I am currently going through a similar debacle in which low potassium resulted in the following:

Heart rate 140, S & T wave changes, QT = 393 QTC = 600

After administration of potassium supplement

Heart rate 80, Normal EKG, QT = 405   QTC = 455


I have had subsequent EKGs with QT values of 388, 412, and 420....all due to heart palpitations and shortness of breath.

[Star3851]

Well, somehow my Electrophysiologist on the paper for genetic testing put that my QTc was 499. I was never informed of this and called to find out what the deal was. The nurse said he had read it off of one og my previous EKGs. Now I am thuroughly freaked out and have made an appointment with Dr. Rosero in Rochester who is a long qt expert. I feel very confused by my current EP. In a letter to my doctor he says the long qt was likely caused by medication I was on, but I was not on any. I have also had Qtcs of 390. Any ideas on how it can go from totally normal to totally prolonged? Unfortunately my appointment in Rochester is not for 3 weeks and I am more terrified than ever to go to sleep and not wake up now!
.

[Star3851]

I was not on any medications at the time. The Qtc on my EKG was 390, he calculated it as 465. I have had two other borderline readings of 447 and 437 for QTc. He also did a stress test on me that he said looked fine. I am still very worried and am now on Cymbalta for anxiety (one of the few antodepressants which does not prolong qt!). We will probably get the genetic test done. 465 seems high based on some online reading I have done, but I guess I have to try and trust the EP.

[is_something_wrong]

You are not alone being concerned about having LQTS on this forum, it seems. I've never seen that many questions about LQTS. A good idea is to read some of the other answers - it may really help.

The relevant question here is - why don't you trust your cardiologist? As none of us are doctors, we can't give you any second opinions, but an important question is, if you can't trust an EP doctor regarding heart rhythm and EKGs, who can you trust?

I guess you (like most of us) has scared yourself by reading online articles about LQTS. I can assure you that none of us, not me, not you, have 1% of the knowledge a cardiologist/EP has about LQTS.

Anyway, some simple facts:
The QT interval represent the systolic phase (a.k.a the phase where the heart pumps blood). A stress test is better than a resting EKG to rule out LQTS. In someone suffering from LQTS, the heart is usually not able to keep a very rapid heart rate because the systolic phase is not "narrowed" like it's supposed to with increasing heart rate. Your autonomic nervous system will determine this phase, and during exercise the systolic phase often narrows more than during a panic attack. Hence, the QTc (which is just a mathematical formula to determine what QT likely would have been at heart rate 60), is often longer if your heart rate is 150 caused by panic than if it was 150 caused by exercise. If your heart is able to narrow the QT interval properly during a stress test (which the cardiologist will notice), you don't have LQTS.

My baseline QTc is approx. 390 msec. On the EKG on my profile, I was very anxious, but my heart rate was slowed with beta blockers. That's causing a short QTc of 358 msec. During a panic attack with a heart rate of 130, I had a corrected QT interval of 450 msec. At max heart rate on my stress test, my QTc was 409 msec.

Trust your cardiologist - forget LQTS :)

[spade22]

LQT1-3 are genetic in origin and family members on your mothers or fathers side would have this syndrome too.  Based on the fact you don't have a family history, it is unlikely you have this (I agree with your dr).  

There are certain medications and electrolyte imbalances that can cause acquired LQTS and this is something that is completely reversible.  Were you on any medications, including any OTC medicines,  when the borderline high values were obtained? Were you otherwise healthy a the time?  About 2% of the population have QTC intervals that are borderline high. Only 1 in about 4000-10000 have the genetic variant of LQTS.

The genetic test has about an 80% Success rate.  Did your doctor mention anything about the fact that the genetic test is very expensive test and it can be very challenging to get our insurance company to pay for it.  The lower your risk factor, the less likely insurance will pay for the test.

[DeltaDawn23]

I can't comment on this specific problem, but it sounds like you've covered all the bases. I understand the anxiety, but if you've had several different doctors, including EP's tell you you are okay, you need to try to believe them.  You have the beta blocker as a safety net.  Try to think of it as a calculated risk. Nothing in life is 100% certain -- it sounds like you are as close to being certain you are okay as it is possible to be. I will be keeping you in my thoughts and prayers as you wait for the genetic test, which I hope will bring you some peace.