Tasty Morsels of EM 054 – Paeds Cardiology: Long QT

1 Aug

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 Now a bit old and superseded by genetics but important to know that it is not all about the QT on the ECG – it’s a syndrome with various factors.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


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