Long QT Syndrome (knowing some facts could save a child's life.



Often we will read about some young kid who appears otherwise healthy dropping dead on the football field, or on the basket ball court. And even though there can be many reasons for this phenomenon, one reason is Long QT Syndrome. It is estimated that 1 in 7000 children have this syndrome, and there may actually be more, as the disease can go undetected. One reason the disease goes undetected is because an EKG, is not done routinely as a baseline, and at milestones in a child's life. The disease is inherited, and so, if a child has the disease, there is a possibility that an adult parent has it. There are many types of Long QT. But either the disease or the tendency to develop it is inherited.


Long QT syndrome is the result of defects in the calcium channels in the heart which prolong the time it takes for the heart to recharge after a beat. Aboveis an electrocardiogram interval that depicts the electrical activity of the heart. Note the QT interval.

A normal time of the re-polarization of the heart is < than .40 millisecond. Intervals above .50 milliseconds are diagnostic. And intervals of .55 milliseconds and beyond, are perilously long and could lead to a fatal arrhythmia called Torsade D e Pointes.



The disease can be asymptomatic, or, the patient may suffer from unexplained dizzy spells. So, whenever a child or an adult has dizzy spells, an EKG should be done to rule out this disease.


Many of the inherited types of long QT are associated with deafness and other congenital abnormalities with the exception of LQT 1 (although some kids with LQ1 have deafness,) the most common type. And so all children who are born deaf should get an electrocardiogram. As well as any child born with skeletal deformities,or other birth defects.


But as stated, there may be no birth defects present and the child or adult may develop the disease as a response to a medication (the tendency to develop the problem with medications though, is genetic – the parents may not have the problem, but should get an EKG if the child is diagnosed.)


Medications that may trigger a long QT problem include the following:




  • Antibiotics (most notably Tetacycline)

  • Antidepressants (such as Prozac, Celexa, or SSRI's but also tetracyclic meds

  • and tricylic antidepressants like Elavil, MAO inhibators are rarely used these days.)

  • Anti fungals

  • Antihistamines

  • Diuretics

  • Heart medications

  • Lipid-lowering medications

  • Oral hypoglycemics (for diabetes)

  • Psychotropic medications (seroquel, and other antipsychotics)


(For more on percipitating and exacerbating meds is here: http://www.azcert.org/medical-pros/drug-lists/drug-lists.cfm


With the increased number of children placed on antidepressants, it would be wise to get a baseline EKG before starting the medication, and another after a blood level is achieved. The medication should be stopped if cardiac symptoms develop (funny sensations in the chest “flip -flops” or chest pain and shortness of breath) or dizziness occurs. And certainly any child put on Ritalin or medications that have an effect on the heart rate should be checked with EKG before the med is started, and several times while on the medication...the reason being that if Ritilan or Adderal is given to a child with Long QT, there is increased risk of an arrhythmia. It is not clear whether Ritlain precipitates Long QT syndrome.


Ways to deal with long QT: Diagnosis and Treatment:


There is some difficulty diagnosing this disease in time because insurance companies do not do EKG routinely. But - the parent does have the authority

to express concerns based on education about the disease to their doctor. Parents can argue for a baseline EKG for their child. They can petition their insurance companies and write legislators to mandate milestone EKG's.


EKG should be part of a routine physical for any child. A child should have an EKG before starting any vigorous sports programs. Coaches should require them before starting athletics. If need be, a parent can pay out of pocket in the case of being cautious about sports, or if the child is starting a psychotropic medication, they should ask for an EKG first.


My child had a long QT interval after an overdose of Celexa. In the emergency room an EKG was done but – ironically - the cardiologist who read his EKG missed his long QT, exactly what you look for in overdose of SSRI medications, he did not notice the QT interval. It was picked up one year later. But we don't know if he had a prolonged QT before the Celexa incident. because we don't have a baseline EKG for comparison. We don't know if the Celexa over dose caused it, we have to assume it did, and avoid it's use because it is on the list for triggering the disease, or exacerbating it. So it is wise to a get a baseline EKG.


Secondly, if the disease is diagnosed, educate yourself, there are many resources on the Internet. The disease is treatable with beta blockers meds and in the worst cases (very prolonged QT) - implantable defibrillator.


Incidentally. It is also a good idea to make sure your child's school is equipped with a defibrillator, and that all staff are trained in it's use. Coaches should bring them to every game. These are our kids, and only our advocacy can protect our children. (Image source of EKG strip: http://www.ecglibrary.com/norm.html )


(Gary Stone is a retired nurse and medical lab technologist
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