Long Qt, nausea, frequent near syncope

[JustWantToKnow]

I have been experiencing a lot of chest pain, dizziness, feeling very faint, have frequent near syncope, lots of nausea, profuse sweating when standing and presently very unstable hypertension.  

My hypertension is normal when I am sitting, morbidly high when I stand, and low when I am asleep.

Should I be concerned about long QT?

I have had several abnormal EKGs.

I noticed on my EKGs:

QT/QTc:  528/451, 464/467, 488/504, 464/471, 512/480

Stress Test:
Minor nonspecific ST t-wave abnormalities, early precordial R-wave transition, PVCs and mild J point depression noted with ST segments being up-sloping, ST - T waves horizontal or downsloping with maximal sinus

Two Holter Tests:
• Ventricular ectopic beats
• Supraventricular ectopic beats
• Isolated PACs – 4 couplets
• Atrial tachycardia – 1 five beat run

• Supraventricular ectopic beats
• PACs – singles – 3 episodes of couplets
• PVCs – 1 episode of couplets
• Ventricular trigeminy – some brief runs
• Mild horizontal or down-sloping ST segment depression – during maximal sinus rate


Echo:  asymmetric left ventricular hypertrophy, dilated right ventricle

My daughter is also experiencing chest pain, dizziness, near fainting, palpitations, nausea and mental fogginess.

Thanks for any information that you share.

[hanora96]

A related discussion, Is frequent syncope in  a 13 year old boy cause for concern? was started.

[heart_of_mine]

For your peace of mind I would seek out an experienced Electrophysiologist to interpret whether or not your QT interval is normal. I get a little tired of doctors immediately suggesting anxiety an overlooking a prolonged QT. Your QT intervals are in the reference range and should be examined further with stress testing to see how your QT interval responds to heart rate changes. If you are a man a QTc of 450 is considered prolonged with Long QT Syndrome being able to be diagnosed with a QTc of 470 and if you are a woman a QTc of 460 is considered prolonged and a QTc of 480 makes it possible to diagnose Long QT Syndrome. There is a small % of the normal population that can have a QTc as high as 480 but that is for an experienced EP to determine.

[JustWantToKnow]

Thank you for your response and your insight.

In answer to your question.

I have never been diagnosed with an anxiety disorder.  I am usually a serene person but sometimes these symptoms can produce some anxiety.

I am concerned about these issues.

I would like to know if there is a relationship between asymmetric left ventricular hypertrophy and the prolonged QT?  

My understanding is that asymmetric left ventricular hypertrophy and long QT are inherited.  Is that correct?

On the 512/480 EKG, the dx reads: Sinus bradycardia, prolonged QT, abnormal ECG.

I had a complete blood workup with these three ekgs:
QT/QTc:  488/504, 464/471, 512/480

I was told that my blood work was fine. (My two prescriptions do not prolong the QT wave.)

After the 512/480 EKG: Sinus bradycardia, prolonged QT, abnormal ECG, (which was done for a presurgery screening, I was sent to my cardiologist for further testing.  My cardiologist cleared me for surgery but the orthopedist refused to do the surgery.  He cited that I was too dangerous.)

No one ever told me about the prolonged QTs on the EKGs.

Recently, I got copies of my medical records for a second opinion from another cardiologist. That is when I read about the prolonged QT.

Shouldn't this have been discussed with me based on my family history?

(I have a strong family history of heart attacks, fainting and sudden death.  My grandfather died suddenly in his early 40s of an MI.  My brother had a MI at age 32 which damaged 25% of his heart. I have other siblings with CABGs, MIs and HF. There are also many other sudden deaths in my family, aunts, uncles, cousins.  There have also been many near deaths where resuscitation was successful.)

Again, thank you for your insight.

[Darcy Green Conaway, MD]

Long QT syndrome is not related to blood pressure-- the two are separate issues.It looks  like only one was dramatically prolonged and at that time you would need to know your electrolytes and medications as many things can prolong these intervals.

Your two Holter's don't show anything dramatically concerning. I would ask how hypertrophied your left ventricle is and whether or not anyone has ever used the term "hypertrophic cardiomyopathy"..

Have you ever been diagnosed with an anxiety disorder?