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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Cardiology
Satisfied Customers: 52482
Experience:  Cardiology Expert
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Hello, I am a 39 year old female with Long QT syndrome, which

Customer Question

Hello, I am a 39 year old female with Long QT syndrome, which is currently managed with 2mg of bisoprolol daily.

Recently I have started experiencing multiple Ventricular Ectopic heartbeats, which have been recorded and identified on a cardiocall.

My cardiologist has increased my bisoprolol to 5mg and plans to record with another cardiocall in January, however even on the increased dose the ectopic beats are happening on a daily basis.

I would very much appreciate a cardiologists thoughts/input on my situation. I am terrified that when the ventricular ectopic beats occur they may trigger a dangerous arrhythmia or torsades des pointes. I appreciate that my panic and stress about this is probably increasing the likelihood of the ectopic beats, but the vicious circle that I find myself in has become unbearable.

I do not know how to manage the ectopic beats when they occur. I don't know whether to treat them as 'panic', 'benign', or consider that they may trigger something more dangerous because of the Long QT.

I would be so grateful for your advice...
Submitted: 3 years ago.
Category: Cardiology
Expert:  Dr. Phil, MD replied 3 years ago.
Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Thanks for this question

How many ectopics per day?

What is your QT now?
Customer: replied 3 years ago.

Thank you so much for your quick response...


 


I think my QT was 454 on my last ECG (I'm afraid I don't have a copy of it!). As far as I'm aware my QT is usually quite borderline. Myself and two of my children have been genetically diagnosed with Long QT.


 


The ectopics happen between 3 and 5 times a day. it may be just the odd few 'flip flops', or less frequently ( once or twice a day) a series of flip flops which feel like they happen every 2 or 3 beats for about 10-15 minutes. It is this that I find particularly frightening as I perceive that my heart is trying to find it's way back to a normal rhythm! The longer episodes tend to follow a rapid increase in heart rate. My normal rate is between 50-60.


 


I hope that info is useful.


 


Many thanks...

Expert:  Dr. Phil, MD replied 3 years ago.
I'm sorry about the late reply Emma

My computer system went down

I am quite concerned about these ectopics.

I think you need seen physically by a doctor sooner
Customer: replied 3 years ago.

Hello
Thank you for your response.

I would very much like to understand the reasons why there may
be need for concern?

I would be very grateful to know your opinion on ventricular
ectopics and whether they may impact my Long QT?

I am also keen to know what may help manage
or treat the symptoms?

Many thanks
Emma
Expert:  Dr. Phil, MD replied 3 years ago.
Hi Emma.

The beta blockers are good for treatment but you may need further therapy.

A drug called mexilitine with propranolol can shorten the QT

You might also need an ICD

The risk is that with too many ectopics it can turn into a lethal arrhythmia
Dr. Phil, MD, Medical Doctor
Category: Cardiology
Satisfied Customers: 52482
Experience: Cardiology Expert
Dr. Phil, MD and other Cardiology Specialists are ready to help you
Expert:  Dr. Phil, MD replied 3 years ago.
I noticed that our chat is not complete.

A positive rating is the only way I am credited for my work. However, my main goal is your 100% satisfaction. If you are satisfied, please rate positively. If not, just click reply and I will happily provide more information.
Customer: replied 3 years ago.

Hello


 


I had hoped you would have been credited as I have rated you above, before your last email.


 


As I am on a free trial, I wonder if you would mind if I put my question out there to gather any other experts thoughts and advice as well?


 


Many thanks for your help,


Emma

Expert:  Dr. Phil, MD replied 3 years ago.
no problem Emma
Expert:  Dr .Saeed ahmed replied 3 years ago.
Hello,

Thank you for your question.

I will try my best to help you with your questions.

I need to ask few questions before first.

Is there history of sudden death in your family ?

Do you have symptoms of dizziness or blackouts ?

Did your doctor performed holter or event monitoring lately ? if yes what did it showed ?

Customer: replied 3 years ago.

Thank you for your response.


 


There is only one possible sudden death of a young person in our family - my nephew drowned.


 


I fainted a number of times as a teenager; the last faint being age 18.


 


In August I had an episode where my heart dropped to 42 with an irregular rhythm, which after a few minutes became very fast. I was admitted to hospital where they said my pulse was slow and blood pressure low, but otherwise all was fine.


 


Since then, I regularly feel dizzy/lightheaded when my heart is going very slow (below 55) or fast (above 130). My heart-rate before the last few months was around 80, so this slow pulse is new for me.


 


I had an event monitor a few weeks ago which showed 'unifocal ventricular ectopic beats'.


 


I have been taking 5mg Bisoprolol since then, but I am still experiencing the ectopic beats, particularly if I have any strong emotion - happy, sad, surprised etc. I have many single, isolated ectopic beats during the day - but also periods of 10 plus minutes where it feels like it is 'sucking', 'missing' every couple of beats.


 


The cardiologist plans another event monitor in January.


 


Many thanks,


Emma


 

Expert:  Dr .Saeed ahmed replied 3 years ago.
Thank you for your reply,

As there is adequate family history of sudden death. As it occured during swimming so it seem that you have long QT type 1 in your family. In all such cases where there is family history of sudden death and symptoms of dizziness regardless of presence of VT on holter or event monitor we opt for ICD in such cases.
Beta blockers are useful but your heart rate is also going too low at some occasions so increase in beta blocker to lower the number of ectopic beats is not an option because this will further lower your heart rate, which can be dangerous.
So best option here is not beta blocker dose increment not mexilitine, it is ICD which can help prevent sudden death.

I hope this helps.

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