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Continuing Education in Anaesthesia, Critical Care & Pain 2008 8(2):67-70; doi:10.1093/bjaceaccp/mkn003
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Long QT syndrome

John D. Hunter, DICM FRCA, Prashast Sharma, MBBS and Sarika Rathi, MBBS
Consultant in Anaesthetics and Intensive Care
Macclesfield District General Hospital
Victoria Road
Macclesfield SK10 3BL
UK
Specialist Registrar in Anaesthetics
Macclesfield District General Hospital
Macclesfield
UK
Specialist Registrar in Anaesthetics
Macclesfield District General Hospital
Macclesfield
UK
Tel: +44 1625 661307 Fax: +44 1625 661436 E-mail: john.hunter@echeshire-tr.nwest.nhs.uk

Key Words: Long QT syndrome (LQTS) is a disorder of myocardial electrical conduction that results in impaired ventricular repolarization and presents clinically as recurrent syncope, pseudo-seizures, or sudden death. • Patients with LQTS are vulnerable to the development of the characteristic polymorphic ventricular tachycardia torsade de pointes. • Anaesthesia and surgery can trigger malignant arrhythmias in those with LQTS. • Magnesium sulphate is the treatment of choice for the prevention of recurrent torsade de pointes. • Patients with known LQTS require review by a cardiologist before anaesthesia.

The first 150 words of the full text of this article appear below.

Long QT syndrome (LQTS) is caused by malfunction of cardiac ion channels impairing ventricular repolarization.1 This predisposes to the development of the polymorphic ventricular tachycardia torsade de pointes (‘twisting of the points’) (Fig. 1). This may either revert spontaneously back to sinus rhythm causing syncope or degenerate to ventricular fibrillation causing sudden death. LQTS can be congenital, in which there are mutations in the genes encoding for the cardiac ion channels, or acquired in which malfunction of the ion channels is caused by drugs or metabolic abnormalities. It is likely that many of those with acquired LQTS have a genetic basis in which common polymorphisms cause subtle alterations in the cardiac ion channels responsible for repolarization.2,3 The increase in sympathetic tone associated with the stress of anaesthesia and surgery can provoke torsade de pointes in those with LQTS, and some drugs used during anaesthesia can prolong the QT interval.


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  		Fig. 1 . . . [Full Text of this Article]

 

   Diagnosis
 

   Pathophysiology
 

   Congenital LQTS
 

   Acquired long QT interval syndrome
 

   Treatment of torsade de pointes
 

   Anaesthesia and LQTS
 

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