QTc Relationship to VT's and PM

Hello friends. Am a dual-chamber PM pt. seeking any feedback as I’m having trouble waiting on answers back from cardio’s office.  Am also going to corner my internist today at my annual physical, for sure.  So here’s the deal.  Have experienced increasing presyncopes, a -NS of syncopes, and what I call “pre-presyncopes” which is an odd feeling that sometimes precedes an “event”.  BP has been all over the place, including dancing crazily with systolic in from 139’s to 190’s!!!! and diastolic from 70’s to over 100. In last couple of weeks HAVE responded to doubling my Olmesartan and it now ranges from normal to mildly high.  Quick background – last spring had stress test because doc hears a gallop and wanted stress test and doppler. to rule-out pulmonary hypertension [I also have a lung disease (bronchiectasis) and I’ve had chronic, intermittent edema of lower extremities in last 1.5 yrs. w/increasing shortness of breath (SOB)].  Doppler only found Grade 1 diastolic dysfunction (impaired relaxation), mild to moderate tricuspid valve regurgitation.  The findings fairly typical for someone my age (62).  A recent episode made me think I’d blacked out and put me back in the ER.  On discharge, I asked for intermittent interrogations and correlated them to a calendar I’d been keeping of the most distressing events – found a very high correlation, especially of the scariest events – so at least it’s not made up, for sure!  PM Interrogation print-outs don’t actually show the typical, benign PVC I’m use to having.  What IS listed:  a bunch of VT (NS – assuming not (significant), and some SVT (ST).  Oddly (happily), the SVT don’t last long – under 2 minutes but enough to cause me to loose footing. Sorry about all the detail.  What I understand the least is this:  My QTc on interrogations are also variable.  Examples:

May:   PR interval  160 ms                July:  184 ms

May:  QRS dur 130 ms                       July: 140 ms

May:   QT/QTc  372/472 ms             July:  422/443

May: PRT axes 70 -59 74                   July: -71-47 57

I did have a follow-up recently but left with more questions than answers.  A partner was filling in for my cardio.  Am awaiting a call from him on his return.  I have an annual physical with my internist (at her insistence) this afternoon.   If anyone could give me feedback on my QTc (which seems, to me, out of the norm), it might help me better formulate questions for her.

Thank you everyone.  So sorry for it being so long!

 

 

             


2 Comments

Long QT intervals

by Selwyn - 2019-07-23 06:03:59

You should not be increasing your ACE2 (Olmesartan) without having renal function testing. 

Electrolyte disturbances can alter your QT interval. Prolonged QT can cause arrhythmias and fatality. 

You need to look quite carefully at the medication(s) you are taking.

 

QTc intervals

by donr - 2019-07-24 23:59:46

Based on what my Cardio told me, the upper limit on a safe QTc is 500  It is less on the actual QT.  The "C" stands for "corrected," I Believe.    I hit 502 a couple times, so he monitors me closely.   I'm guessing there is some margin for  error, or he would have done somethig more drastic, I'm sure.  I'm on Sotalol, apparently notorious for affecting QT/QTc.  I'm going to try to get a ECG t6omorrow, since it's been 60 days since my last one.

Donr

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