ECG library
Long QT in an adolescent with syncope
core15 years old· adolescentA 15-year-old who collapsed during a swimming race, with a brief jerking episode witnessed by the coach. A cousin died suddenly at 19.
25 mm/s · 10 mm/mV · synthetic tracing
100%
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.
Key findings
- QTc above 500 ms
- Exertional syncope with a 'seizure'
- Sudden death in a young relative
Learning points
- Measure the QT yourself and correct it: a machine QTc on a teenager with sinus arrhythmia is often wrong in both directions.
- Exertional or startle syncope, swimming, a witnessed 'seizure' with quick recovery, and a family history of early sudden death are red flags that turn a faint into a cardiology referral.
- Beta blockade, avoiding QT-prolonging drugs, and screening the family are the plan the cardiologist makes; the ward's job is to recognise the pattern and not send her home with a diagnosis of epilepsy.
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