128 conditions associated with prolonged qt syndrome

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CONDITIONS ASSOCIATED WITH PROLONGED QT SYNDROME :- Congenital :- Romanowald syndrome  Normal hearing Jervell and lange Nielsen  Sensorineural hearing syndrome T/T = Beta Blockers. 129
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Acquired :- Antiarrythmic drugs :- IA — Quinidine, procainamide,Disopyramide IC — Encainide, Flecainide Class III — Sotatol, Amiodarone TCA'S Antibiotics (macrolides, cotrimoxazole) Terfenadine (when combined with macrolides or antifungal) 130
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Metabolic :- Hypokalemia Hypocalcemia Hypomagnesemia T/T of acquired prolonged QT syndrome Atrial or ventricular overdrive pacing Magnesium 131
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TdP secondary to hypokalaemia: Sinus rhythm with inverted T waves, prominent U waves and a long Q-U interval due to severe hypokalaemia (K+ 1.7) A premature atrial complex (beat #9 of the rhythm strip) lands on the end of the T wave, causing ‘R on T’ phenomenon and initiating a paroxysm of polymorphic VT. Because of the preceding long QU interval, this can be diagnosed as TdP. 133
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Cardiac arrhythmia , also known as cardiac dysrhythmia or irregular heartbeat , is a group of conditions in which the heartbeat is irregular, too fast, or too slow. Tachycardia Bradycardia Cardiac Arrhythmias 134
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There are four main types of arrhythmia : 1. extra beats, 2. supraventricular tachycardias, 3. ventricular arrhythmias, and 4. bradyarrhythmias. . Extra beats include :- 1. Premature atrial contractions and 2. Premature ventricular contractions. . Supraventricular tachycardias include :- 1. Atrial fibrillation, 2. Atrial flutter, and 3. Paroxysmal supraventricular tachycardia. 135
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Ventricular arrhythmias include :- 1. Ventricular fibrillation and 2. Ventricular tachycardia . Bradyarrhythmias :- 1. Sinus Bradycardia 2. Sinus Pause and Sinus Arrest 3. Sino-atrial Exit Block 136
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ATRIAL FIBRILLATION 138
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Causes of Atrial fibrillation :- Rheumatic heart disease (MS and MR) Non - rheumatic mitral valve disease Hypertensive cardio-vascular disease. Dilated cardiomyopathy Atrial septal defect Coronary heart disease. Thyrotoxicosis Acute alcohol excess and alcohol withdrawal. In predisposed individuals even consumption of small amount of alcohol may precipitate atrialfibrilation (this is known as holiday heart syndrome). 139
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Irregularly irregular rhythm. No P waves. Absence of an isoelectric baseline. Variable ventricular rate. QRS complexes usually < 120 ms unless pre-existing bundle branch block, accessory pathway. ECG Features of Atrial Fibrillation 140
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Risk of Stroke and Anticoagulation Stroke risk stratification requires either an assessment of risk factors or application of a risk score e.g. CHADS 2 Management of Atrial Fibrillation 141
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To prevent stroke in AF the following recommendations have been made :- Atrial fibrillation associated with risk factor Anticoagulation with warfarin unless contraindicated Atrial fibrillation without risk  Aspirin Anticoagulation strategies may include warfarin, aspirin, clopidogrel and newer agents such as dabigatran.
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  • Winter '16
  • jean grey
  • Cardiac electrophysiology, QRS, Rate

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