QT Syndrome
P. Revathy1, Madhumitha K2
1Nursing Emergency Incharge, Kauvery Heartcity, Trichy, India
2Emergency Senior Staff Nurse, Kauvery Heartcity, Trichy, India
*Correspondence: nursing.heartcity@kauveryhospital.com
Abstract
Long QT Syndrome ( LQTS) is a rate cardiovascular disorder that affects the hearts electrical system, resulting in irregular and potentially Life -threatening arrthymias individuals with LQTS have congenital disorder characterized by a prolongation of the QT internal on electrocardiograms and a propensity to ventricular tachyarrhythmias, which may lead to syncope, cardiac arrest, or sudden death.
Background
Congenital long QT syndrome characterized by heart rate corrected QT INTERVAL P relocation and life-threatening arrhythmias, leading to syncope and sudden death .the electrocardiographic QT interval reprints the depolarization and the repolarization phases of the cardiac action potential.
Patient had recurrent syncope and seizure since 10yrs of age, is aggravated for past one week. so patient admitted, medicine treatment was given, and ICD Procedure was successfully done.
Definition
Long QT syndrome (LQTS) is a problem with the hearts electrical conduction system that may prevent the heart from pumping properly, leading to palpitations, blackouts, seizures and life threatening arrhythmias.
QT Intervel for Both Male and Female According to age groups:
- For males and females below 15years of age:
Normal QT interval: 0.35 -0.44 seconds
Borderline QT interval: 0.44-0.46seconds
Prolonged QT interval: more than 0.46seconds
- For Adult males:
Normal QT interval: 0.35 -0.43 seconds
Borderline QT interval: 0.43-0.45seconds
Prolonged QT interval: more than 0.45seconds
- For adult females:
Normal QT interval: 0.35 -0.45 seconds
Borderline QT interval: 0.45-0.47seconds
Prolonged QT interval: more than 0.47seconds
Symptoms of Patient:
- Syncope
- Seizure
- Loss of appetite
- Tiredness
Case Presentation
A 43-year-old female patient came to the Emergency department with history of Recurrent syncope and seizure since 10 yrs of age, which is aggravated for past 1 week. She was on levetiracetam 100 mg once daily for past 33 yrs. She had family history of consanguineous marriage, sudden death of her younger brother at age of 8 years. Her younger son also has similar complaints of recurrent syncope. Physical examination revealed no abnormality laboratory investigation were within normal limit. ECG revealed prolonged corrected QT OF595 second on chest leads. Echocardiography revealed dilated cardiomyopathy, mild left ventricular dysfunction within EF-45% mild mitral regurgitation and grade 3 diastolic dysfunction.
In view of above findings age was diagnosed to have LQTS and admitted in CCU patient was managed with isoprenaline infusion and anti-arrhythmic. Ultrasound guided left stellate ganglion block was done. Then neuro surgery opinion was sought and patient underwent left stellate ganglionectomy. This procedure involves removing specific nerve clusters responsible for regulating heart rate and rhythm.
Following the successful ganglionectomy and implantable cardioverter – defibrillator (ICD) was surgically implanted under the patients skin near her collarbone, and was programmed to monitor and deliver electrical shock if necessary, ultimately ensuring her heart maintain a normal rhythm during any potential arrthymia episodes. Post-surgery the patients quality of life has been tremendously enhanced. The recurrence of syncope and seizures has significantly reduced, allowing her to regain her independence and resume activities she once avoided.
ECG
ECHO Report
X-Ray
Immediate care
- The patient was stabilizing initially at the casualty.
- Inj.Amidarone 50 mg IV infusion started as order by the consultant.
- The general assessment made from head to toe.
- The vital functions assessed.
- The patients condition was explained to the patients attenders and consent was obtained for further treatment.
- The patient took her medication, which her obstetrician had prescribed.
Nursing Care provided
- The patient shifted to CCU for further close monitoring.
- Vital signs constantly monitored and intake and output maintained.
- Basic blood investigations done. Investigation included CBC, ESR, SODIUM, POTASSIUM, RFT, and blood group and typing.
- Nurses followed AIDED techniques (knowledge, introduction, duration, explanation and thanks) of communication with patient and participation to gain their trust and improve the statistical level.
- We advised her to take a Low Fat Diet.
- Apart from all this care, patient was emotionally very much disturbed and was scared. We nurse talked to her and supported her psychologically throughout her hospital stay. Patient was much overwhelmed.
- Patient was discharged on 04.08.2023 with good hemodynamically status.
- The advised discharge medications are,
Discharge Medication Advice
- Tab.Inderal 40mg 1-1-1
- Tab.Mexiletine 50mg 1-0-1
- Tab.Ranolaz 500mg 1-0-1
- Tab.Levipil 500mg 1-0-1
- Tab.Rantac 150mg 1-0-1(BEFORE FOOD)
- Tab.Ceftum 500mg 1-0-1* 5DAYS
We scheduled her review after 2 weeks from the discharge date and she advised to follow all the instructions at her home as well.
Outcome
The patient returned home happy. The family appreciated us saving the Patient life.
Discussion
The patient received the most appropriate treatment at the right time with symptoms of symptomatic syncope and seizure.
Ms. Revathy P
Emergency Incharge, Kauvery Heartcity
Ms. Madhumitha K
Emergency Senior Staff Nurse, Kauvery Heartcity