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Many people with long QT syndrome have no signs or symptoms.
Some people may experience the following symptoms:
- Fainting (or syncope). This may occur when the patient is emotionally or physically stressed. It is unusual in QT syndrome to have any signs before the person actually faints.
- Seizures
- Sudden death. If there is sudden death, and doctors suspect long QT syndrome as the cause, they may recommend that the family members of the deceased get tested for the disease.
LGL syndrome is diagnosed on the basis of the surface EKG in a symptomatic individual with a PR interval less than or equal to 0.12 second (120 ms) with normal QRS complex configuration and duration. It can be distinguished from WPW syndrome because the delta waves seen in WPW syndrome are not seen in LGL syndrome. It is a clinical diagnosis that came about before the advent of electrophysiology studies. Be aware, however, that not all WPW EKG's have a delta wave; the absence of a delta wave does not conclusively rule out WPW.
Individuals with LGL syndrome do not carry an increased risk of sudden death. The only morbidity associated with the syndrome is the occurrence of paroxysmal episodes of tachycardia which may be of several types, including sinus tachycardia, supraventricular tachycardia, atrial fibrillation, atrial flutter, or even ventricular tachycardia.
A triad of hypokalemic periodic paralysis, potentially fatal cardiac ventricular ectopy and characteristic physical features is known as Anderson-Tawil Syndrome. It affects the heart, symptoms are a disruption in the rhythm of the heart's lower chambers (ventricular arrhythmia) in addition to the symptoms of long QT syndrome. There are also physical abnormalities associated with Andersen–Tawil syndrome, these typically affect the head, face, and limbs. These features often include an unusually small lower jaw (micrognathia), low-set ears, and an abnormal curvature of the fingers called clinodactyly. Furthermore it causes symptoms which are similar to Long QT syndrome, which Andersen's is also known as. Long QT syndrome, a hereditary disorder that usually affects children or young adults, slows the signal that causes the ventricles to contract. Another electrical signal problem, atrial flutter, happens when a single electrical wave circulates rapidly in the atrium, causing a very fast but steady heartbeat. Heart block involves weak or improperly conducted electrical signals from the upper chambers that can't make it to the lower chambers, causing the heart to beat too slowly. These conditions can put you at risk for cardiac arrest. Treatment might involve medication, ablation, or an implanted device to correct the misfiring, such as a pacemaker or defibrillator. Here are some common physical abnormalities, but keep in mind these do vary (in severity) between each patient:
Some more severe issues can be caused via the potassium channelopathy. These include paralysis (mostly temporary and can last from several seconds to several minutes), inability to perform long distance/interval exercises and sudden exhaustion- although this can be a sign of cardiac arrhythmia- which should be immeditaley checked out by a GP, whether you have been diagnosed with ATS or not.
No specific set of criteria has been developed for diagnosis of pacemaker syndrome. Most of the signs and symptoms of pacemaker syndrome are nonspecific, and many are prevalent in the elderly population at baseline. In the lab, pacemaker interrogation plays a crucial role in determining if the pacemaker mode had any contribution to symptoms.
Symptoms commonly documented in patients history, classified according to cause:
- Neurological - Dizziness, near syncope, and confusion.
- Heart failure - Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and edema.
- Hypotension - Seizure, mental status change, diaphoresis, and signs of orthostatic hypotension and shock.
- Low cardiac output - Fatigue, weakness, dyspnea on exertion, lethargy, and lightheadedness.
- Hemodynamic - Pulsation in the neck and abdomen, choking sensation, jaw pain, right upper quadrant (RUQ) pain, chest colds, and headache.
- Heart rate related - Palpitations associated with arrhythmias
In particular, the examiner should look for the following in the physical examination, as these are frequent findings at the time of admission:
- Vital signs may reveal hypotension, tachycardia, tachypnea, or low oxygen saturation.
- Pulse amplitude may vary, and blood pressure may fluctuate.
- Look for neck vein distension and cannon waves in the neck veins.
- Lungs may exhibit crackles.
- Cardiac examination may reveal regurgitant murmurs and variability of heart sounds.
- Liver may be pulsatile, and the RUQ may be tender to palpation. Ascites may be present in severe cases.
- The lower extremities may be edematous.
- Neurologic examination may reveal confusion, dizziness, or altered mental status.
Short QT syndrome is a genetic disease of the electrical system of the heart. It consists of a constellation of signs and symptoms, consisting of a short QT interval on an EKG (≤ 300 ms) that does not significantly change with heart rate, tall and peaked T waves, and a structurally normal heart. Short QT syndrome appears to be inherited in an autosomal dominant pattern, and a few affected families have been identified.
Long QT syndrome (LQTS) is a condition which affects repolarization of the heart after a heartbeat. This results in an increased risk of an irregular heartbeat which can result in fainting, drowning, or sudden death. These episodes can be triggered by exercise or stress. Other associated symptoms may include hearing loss.
Long QT syndrome may be present at birth or develop later in life. The inherited form may occur by itself or as part of larger genetic disorder. Onset later in life may result from certain medications, low blood potassium, low blood calcium, or heart failure. Medications that are implicated include certain antiarrhythmic, antibiotics, and antipsychotics. Diagnosis is based on an electrocardiogram (EKG) finding a corrected QT interval of greater than 440 to 500 milliseconds together with clinical findings.
Management may include avoiding strenuous exercise, getting sufficient potassium in the diet, the use of beta blockers, or a implantable cardiac defibrillator. Without treatment there is a 50%, 10 year risk of death, for the inherited versions. With treatment this decreases to less than 1% over 20 years.
Long QT syndrome is estimated to affect 1 in 7,000 people. Females are affected more often than males. Most people with the condition develop symptoms before they are 40 years old. It is a relatively common cause of sudden death along with Brugada syndrome and arrhythmogenic right ventricular dysplasia. In the United States it results in about 3,500 deaths a year. The condition was first clearly described in 1957.
Brugada syndrome (BrS) is a genetic condition that results in abnormal electrical activity within the heart, increasing the risk of sudden cardiac death. Those affected may have episodes of passing out. Typically this occurs when a person is at rest.
It is often inherited from a person's parent with about a quarter of people having a family history. Some cases may be due to a new mutation or certain medications. The abnormal heart rhythms can be triggered by a fever or increased vagal tone. Diagnosis is typically by electrocardiogram (ECG), however, the abnormalities may not be consistently present.
Treatment may be with an implantable cardioverter defibrillator (ICD). Isoproterenol may be used in those who are acutely unstable. In those without symptoms the risk of death is much lower, and how to treat this group is unclear. Testing people's family members may be recommended.
Between 1 and 30 per 10,000 people are affected. Onset of symptoms is usually in adulthood. It is more common in people of Asian descent. Males are more commonly affected than females. It is named after the Spanish cardiologists Pedro and Josep Brugada who described the condition in 1992. Their brother Ramon Brugada described the underlying genetics in 1998.
Andersen–Tawil syndrome, also called Andersen syndrome and Long QT syndrome 7, is a form of long QT syndrome. It is a rare genetic disorder, and is inherited in an autosomal dominant pattern and predisposes patients to cardiac arrhythmias. Jervell and Lange-Nielsen Syndrome is a similar disorder which is also associated with sensorineural hearing loss. It was first described by Ellen Damgaard Andersen.
Pacemaker syndrome is a disease that represents the clinical consequences of suboptimal atrioventricular (AV) synchrony or AV dyssynchrony, regardless of the pacing mode, after pacemaker implantation.
It is an iatrogenic disease—an adverse effect resulting from medical treatment—that is often underdiagnosed. In general, the symptoms of the syndrome are a combination of decreased cardiac output, loss of atrial contribution to ventricular filling, loss of total peripheral resistance response, and nonphysiologic pressure waves.
Individuals with a low heart rate prior to pacemaker implantation are more at risk of developing pacemaker syndrome. Normally the first chamber of the heart (atrium) contracts as the second chamber (ventricle) is relaxed, allowing the ventricle to fill before it contracts and pumps blood out of the heart. When the timing between the two chambers goes out of synchronization, less blood is delivered on each beat. Patients who develop pacemaker syndrome may require adjustment of the pacemaker, or fitting of another lead to better coordinate the timing of atrial and ventricular contraction.
Genetic testing for Brugada syndrome is clinically available and may help confirm a diagnosis, as well as differentiate between relatives who are at risk for the disease and those who are not. Some symptoms when pinpointing this disease include fainting, irregular heartbeats, and chaotic heartbeats. However, just detecting the irregular heartbeat may be a sign of another disease, so the doctor must detect another symptom as well.
Even though many types of sick sinus syndrome produce no symptoms, a person may present with one or more of the following signs and symptoms:
- Stokes-Adams attacks – fainting due to asystole or ventricular fibrillation
- Dizziness or light-headedness
- Palpitations
- Chest pain or angina
- Shortness of breath
- Fatigue
- Headache
- Nausea
Some individuals with short QT syndrome frequently complain of palpitations and may have unexplained syncope (loss of consciousness). Mutations in the "KCNH2", "KCNJ2", and "KCNQ1" genes cause short QT syndrome. These genes provide instructions for making proteins that act as channels across the cell membrane. These channels transport positively charged atoms (ions) of potassium into and out of cells. In cardiac muscle, these ion channels play critical roles in maintaining the heart's normal rhythm. Mutations in the "KCNH2", "KCNJ2", or "KCNQ1" gene increase the activity of the channels, which changes the flow of potassium ions between cells. This disruption in ion transport alters the way the heart beats, leading to the abnormal heart rhythm characteristic of short QT syndrome. Short QT syndrome appears to have an autosomal dominant pattern of inheritance.
Short QT syndrome is associated with an increased risk of sudden cardiac death, most likely due to ventricular fibrillation.
Clinically, it is often asymptomatic by itself and considered benign in nature.
People with WPW are usually asymptomatic when not having a fast heart rate. However, individuals may experience palpitations, dizziness, shortness of breath, or infrequently syncope (fainting or near fainting) during episodes of supraventricular tachycardia. The telltale "delta wave" may sometimes be seen on an electrocardiogram (ECG/EKG).
Sick sinus syndrome (SSS), also called sinus dysfunction, or sinoatrial node disease ("SND"), is a group of abnormal heart rhythms (arrhythmias) presumably caused by a malfunction of the sinus node, the heart's primary pacemaker. Tachycardia-bradycardia syndrome is a variant of sick sinus syndrome in which the arrhythmia alternates between slow and fast heart rates. Tachycardia-bradycardia syndrome is often associated with ischemic heart disease and heart valve disease.
Wolff–Parkinson–White syndrome (WPW) is a disorder due to a specific type of problem with the electrical system of the heart which has resulted in symptoms. About 40% of people with the electrical problem never develop symptoms. Symptoms can include an abnormally fast heartbeat, palpitations, shortness of breath, lightheadedness, or syncope. Rarely cardiac arrest may occur. The most common type of irregular heartbeat that occurs is known as paroxysmal supraventricular tachycardia.
The cause of WPW is typically unknown. A small number of cases are due to a mutation of the PRKAG2 gene which may be inherited from a person's parents in an autosomal dominant fashion. The underlying mechanism involves an accessory electrical conduction pathway between the atria and the ventricles. It is associated with other conditions such as Ebstein anomaly and hypokalemic periodic paralysis. Diagnosis is typically when an electrocardiogram (ECG) show a short PR interval and a delta wave. It is a type of pre-excitation syndromes.
WPW syndrome is treated with either medications or radiofrequency catheter ablation. It affects between 0.1 and 0.3% in the population. The risk of death in those without symptoms is about 0.5% per year in children and 0.1% per year in adults. In those without symptoms ongoing observation may be reasonable. In those with WPW complicated by atrial fibrillation, cardioversion or the medication procainamide may be used. The condition is named after Louis Wolff, John Parkinson, and Paul Dudley White who described the ECG findings in 1930.
Most people with Wenckebach (Type I Mobitz) do not show symptoms. However, those that do usually display one or more of the following:
- Light-headedness
- Dizziness
- Syncope (fainting)
Familial atrial fibrillation is an autosomal dominant heart condition that causes disruptions in the heart's normal rhythm. This condition is characterized by uncoordinated electrical activity in the heart's upper chambers (the atria), which causes the heartbeat to become fast and irregular.
It occurs because the duration of the refractory period of the myocardium is proportional to the R-R interval of the preceding cycle. A short R-R interval is associated with a shorter duration of action potential and vice versa. A long R-R cycle will prolong the ensuing refractory period, and if a shorter cycle follows, the beat terminating the cycle is likely to be conducted aberrantly. Because the refractory period of the right bundle branch is longer than the left, the right bundle will still be in the refractory period when the supraventricular impulse reaches the His-Purkinje system, resulting in a complex with right bundle branch morphology.
Torsades de pointes or torsade depointes (TdP or simply torsade(s)) (, translated as "twisting of the points"), is a specific type of abnormal heart rhythm that can lead to sudden cardiac death. It is a polymorphic ventricular tachycardia that exhibits distinct characteristics on the electrocardiogram (ECG). It was described by Dessertenne in 1966. Prolongation of the QT interval can increase a person's risk of developing this abnormal heart rhythm.
Up to ~85% of people with NS have one of the following heart defects:
- Pulmonary valvular stenosis (50–60%)
- Septal defects: atrial (10–25%) or ventricular (5–20%)
- Hypertrophic cardiomyopathy (12–35%)
Second-degree atrioventricular block (AV block) is a disease of the electrical conduction system of the heart. It is a conduction block between the atria and ventricles. The presence of second-degree AV block is diagnosed when one or more (but not all) of the atrial impulses fail to conduct to the ventricles due to impaired conduction. It is classified as a block of the AV node and is categorized in between first-degree (slowed conduction) and third degree blocks (complete block).
In right atrial isomerism, both atria of the heart are morphological right atria leading to associated abnormalities in the pulmonary venous system. In addition, individuals with right atrial isomerism develop asplenia, a midline liver, malrotation of the small intestine and the presence of two morphologic right lungs. Individuals with left atrial isomerism, by comparison, have two morphologic left atria, polysplenia, intestinal malrotation and two morphologic left lungs.
The majority of cases present at the time of birth or within a few days or weeks. Presenting signs and symptoms of the congenital heart defect may include cyanosis, breathlessness, lethargy and poor feeding.
Trifascicular block is a problem with the electrical conduction of the heart. It is diagnosed on an electrocardiogram (ECG/EKG) and has three features:
- prolongation of the (first degree AV block)
- right bundle branch block
- either left anterior fascicular block or left posterior fascicular block.