Guest Shine-on Posted March 6, 2010 Share Posted March 6, 2010 just would like some feedback from those with long experience:o... What should be done if you happen to pick up a long QT on a routine screening EKG done in private practice office? The patient is in there 50's ...no chest pain issues...no syncopal episodes. The patient is on a medication for Depression that is associated with prolonged QT. Other than stopping the medication and switching to a better choice of med..... what other steps would you take?? Link to comment Share on other sites More sharing options...
sbellin Posted March 7, 2010 Share Posted March 7, 2010 Check lytes including mag and a TSH. If the prolongation resolves with drug cessation I would do nothing other then warn the patient about other medications that potentially prolong QT. If it does not then a cardiac consult may be in order. A lot depends on how long the prolongation is. Link to comment Share on other sites More sharing options...
andersenpa Posted March 7, 2010 Share Posted March 7, 2010 As above. Several antidepressants prolong QT, so switching agents may be tricky. Best is to hold it and recheck the ECG. Optimize lytes. Congenital LQTS is a slim possibility at this age. QT prolonging drugs- remembers the "Anti"s: Antibiotics Antipsychotics Antidepressants Antiarrhythmics Link to comment Share on other sites More sharing options...
NoClinic4Me Posted November 11, 2011 Share Posted November 11, 2011 Yep, I'd avoid the drugs here http://www.qtdrugs.org/ . I'd ensure I did a very thorough family history for incidences of SCD. Also, any congenital deafness in the family? One type of congenital LQTS is associated with that. I'd also probably refer to EP for a look of the QT was markedly prolonged, just to cover yourself in case of an SCD episode. I could see the lawyers eating that up if you documented LQTS and didn't do a workup. Pat Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 11, 2011 Moderator Share Posted November 11, 2011 make sure rate corrected Link to comment Share on other sites More sharing options...
NoClinic4Me Posted November 11, 2011 Share Posted November 11, 2011 make sure rate corrected The QTc should be on the ECG (top left usually). NEVER use just the QT. Totally agree. Pat Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 12, 2011 Moderator Share Posted November 12, 2011 Oh yeah and never trust the machine..... Get out you calipers.......... Link to comment Share on other sites More sharing options...
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