Question about QTc/ ECG

[Klieko]

Hi,

To make a long story short, in June they found a prolonged (530 ms) QTc during a stress test, and like 470-480 on normal ECG. Because I was going to Vancouver in 4 days (for 6 months), they decided to examine this in January. In Vancouver I became dizzy during exercise, I emailed my cardiologist and he advised me Beta blockers (metoprolol 50 mg). They worked good for the first two months but then I felt dizzy again and got palpitations during exercise. I had a holter monitor with me for 24 hours to see if they could 'catch' the problem.

I just got the results, and there were no significant problems (arrhythmia's), I asked the GP if there was any prolonged QT time, he looked 2 seconds and said no, he said I could stop with the beta blockers. I took it home, so I could show it to my cardiologist in Holland. I looked at the results and they did not measured the QT time??? I tried to do it, it is not that hard and I found an average QT time of 504 ms, but I might made a mistake. I also had a tachycardia ( I was watching TV) of 162 that looked funny (The T-wave never comes down and goes over in the P wave,it looks like the T wave has mutiple peaks, there is a picture in the normal heart rhythm forum). What was remarkable for me was that the QT time did not shorten with a faster heart rate.

My father died in a car accident, nobody knows how it happend. His mom and sister faint a lot and my brother was diagnosed with epilepsy when he was young, he fainted in bath, no unexplained deaths in the family as far as I know of. I (26 yr) get dizzy/ palpitations/ chest pain when I'm startled, when I swim under water, with exercise.

So my questions are: should I stop taking the beta blockers, and is the funny looking strip because of movement or another artefact?
I'm going home in 4 weeks and for an appointment with an EP that is to fast.

Thanks a lot,

[Michael J. McWilliams, M.D.]

I can't advise you on medications -- that crosses legal boundaries that I cannot do.

There are several concerning aspects to your history:
QTc doesn't shorten with exercise
arrhythmia on monitor
syncope with exercise
family history of seizures, etc.

I would pay very close attention to a patient with those characteristics in my clinic.
I would probably do genetic testing.
I would advise against strenuous exercise.
I would continue the beta blocker.

This is not advise for you because I cannot do that, but this is how I would approach a patient in clinic.

Qt intervals are very difficult to interpret.  It is best to see a specialist as soon as possible.  I hope this helps.

[Klieko]

Hi,

Yes this helps,

So you think the tachycardia strip is not due to a artefact?

Thanks a lot for the information

Lieke