The long QT syndrome

Publish Year: 1398
نوع سند: مقاله کنفرانسی
زبان: English
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CCRMED03_135

تاریخ نمایه سازی: 20 بهمن 1398

Abstract:

The long QT syndrome is a disorder of myocardial re-polarisation characterized by a prolonged QT- interval on the ECG, which may be either congenital or acquired and can be associated with seizure-like symptoms. Moreover, it can manifest with syncope or tonic-clonic seizures, thus its diagnosis and management pose major concerns.Case Presentation:A 52 years old male presented to the ED following a tonic-clonic seizure. Further investigation demonstrated a prior history of meningoencephalitis and two more previous occasions of seizures over the previous year. The patient mentioned taking sotalol few days before, too. The physician in charge of his treatment administered phenytoin for the patient. 10 minutes later the patient developed recurrent ventricular tachycardia, which was controlled by amiodarone and defibrillation on each occasion. The patient was then despatched to the heart centre. Upon arrival his heart rate was 75 bpm, his blood pressure 110/70, and the lab tests only showed an Hb of 6.2 gr/dl. 15 minutes later, the patient suffered from recurrent ventricular tachycardia again and received amiodarone and defibrillation accordingly. Eventually, patient’s rhythm turned into torsade de pointes, which was treated by 200j asynchronised defibrillation and 2 grams of magnesium sulphate administered over 60 seconds. The following rhythm was bradycardia and so the amiodarone infusion was ceased and atropine was administered.The final ECG showed a QT-interval of 62 Msec. And the consulting cardiologist candidated the patient for overdrive pacing.Conclusion:Increasing evidence indicates that edications such as phenothiazines and antiepileptics as well as electrolytes imbalances such as hypomagnesemia play pivotal roles in the development of TDP and their corrections are important in the resolution of TDP. Also, in these patients class IA and IC should be avoided, however, empirical magnesium sulphate is effective and must be considered.