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Cardiology

ECG Quiz 2- Answer

Other ECG Quizzes

The bottom holter strips show "Torsades des pointes", or polymorphic VT. During sinus rhythm in the upper panel, the QT interval is 480 ms & the corrected QT interval (QT/square root of RR) is 620 ms. This patient has long QT syndrome with polymorphic VT.

Approach to management:

  1. Rule out all causes of acquired long QT & correct the underlying abnormality eg. hypokalemia, hypomagnesemia, erythromycin, astemizole, Class IA & III anti-arrhythmic drugs, liquid protein diet etc.
  2. Beta-blockers are the drugs of first choice in congenital long QT syndrome & often many patients have significant bradycardia requiring B blocker + permanent pacemaker.
  3. Left cervical sympathectomy may be performed in experienced centers.
  4. Automatic implantable cardioverter defibrillator implantation in malignant or resistant patients.
  5. In certain patients mexilitine or potassium sparing drugs may have to be used.
  6. A detailed family history & screening is very important.