Saturday, June 01, 2013

Long QT: what hospitalists need to know

Here is an update in the American Journal of Emergency Medicine. Both the congenital and acquired forms are discussed. For congenital LQTS beta blockers are mentioned as first line therapy. The general principle guiding this recommendation is based on two different types of triggers for Torsades in patients with long QT: sympathetic surge (generally seen in the congenital form) and increased cardiac cycle length in the form of pause or bradycardia (the usual trigger in acquired cases). Overlap exists, however. Some acquired cases represent a mutation with weak expression, the phenotype manifesting for the first time in the face of an external factor such as an electrolyte disturbance or drug effect. And while the majority of genotypes respond to beta blockers some may not. The usual role of the hospitalist is to recognize abnormal repolarization in its various forms and address external triggers such as drugs and electrolyte disturbances, and know when to call the electrophysiologist.

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