As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure.
Today we have some notes from a lecture by a paeds cardiologist at a recent national EM training day.
The first is on long QT
- the Schwartz score can be useful for diagnosis of long QT syndrome. Now a bit old and superseded by genetics but important to know that it is not all about the QT on the ECG – it’s a syndrome with various factors.
- T wave alternans is a marker of ventricular instability
- 3 main provocations of arrhythmia
- swimming
- arguing
- alarm clocks
- long QT in the first 2 weeks of life will usually be normal
- like many folk he emphasised the importance of manual measurement of QT
- beta blockers really good for this disease. Only if you have an event on a beta blocker do you get an ICD implanted
- there are the Bethseda guidelines on exercise which tend to be very conservative. There are some recent moves to relax this
- if you find someone with syncope and a long QT then they probably don’t need admitted but this totally depends on the paeds cardiology service you have – they need to have a planned follow up and in my opinion if you’re in a system where you can’t get that then maybe admitting them is the way to go