Tasty Morsels of EM 010

2 Jul

I keep a little, ever-expanding note on my phone where I jot down little morsels of goodness that I pick up while listening to or reading one of the many excellent sites/podcasts in the useful resource section.

I’ll try and transfer them here for your enlightenment.

From the  mighty ER Cast on paediatric syncope:

  • When you think of exercise related syncope it’s worth splitting it into 2
  1. exhaustion/dehydration related syncope with prodrome (not so worrying)
  2. sudden with no warning (more worrying)
  • The examination is all about murmurs but you will never know all the ins and outs so remember what’s normal
  • the HOCM murmur should get louder with valsalva (the innocent ones should get quieter)
  • ECG is probably the most useful test. Some points
  1. if speed is a problem speed up the paper to 50mm/sec
  2. look for WPW
  3. look for long QT (unfortunately they don’t give us a useful number to think of; in kids they vary; in adults >450 is abnormal but I don’t get excited till >500)
  4. long QT can be congenital or acquired; macrolides and anti-psychotics will commonly bump up your QT
  5. old man LVH should make you think HOCM
  6. look out for Brugada
  • they make the important point that checking a blood sugar is useless in the awake patient in front of you. If low sugar caused them to go down then if they’re awake now the sugar will be normal. If they’re altered then go ahead but if they’re normal then it’s not useful
  • they also note all the silly names for common fainting that have no clinical relevance though it does make us look smart when we use them
A question:
  • anyone know if the long QT/Brugada/WPW have arrhythmias that are exercise induced?

2 Replies to “Tasty Morsels of EM 010

  1. GDay,

    The congenital Long-QT Syndromes can certainly degenerate into nasty arrhythmias (Torsades, VF) if trigerred by events like exercise or extremes of emotion. I think it’s related to the R on T during tachycardia…?

    I like this history of the Long-QT Syndromes from Wikipedia… I guess the point is that triggers such as being frightened/emotions can trigger nasty arrythmias in those primed with congenital Long-QT syndrome. And it’s a reminder that a big subset of the congenital syndromes are associated with deafness…

    “The first documented case of Long QT syndrome was described in Leipzig by Meissner in 1856, where a deaf girl died after her teacher yelled at her. When the parents were told about her death, they told that her older brother who also was deaf died after a terrible fright.[10] This was several decades before the ECG was invented, but is likely the first described case of Jervell and Lange-Nielsen syndrome. In 1957, the first case documented by ECG was described by Anton Jervell and Fred Lange-Nielsen, working in Tønsberg, Norway.[11] Italian pediatrician Cesarino Romano, in 1963,[12] and Irish pediatrician Owen Conor Ward, in 1964,[13] separately described the more common variant of Long QT syndrome with normal hearing, later called Romano-Ward syndrome. The establishment of the International Long-QT Syndrome Registry in 1979 allowed numerous pedigrees to be evaluated in a comprehensive manner. This helped in detecting many of the numerous genes involved.[14]”

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