You are evaluating a 13-year-old whose father recently drowned while swimming laps in a pool. Upon further inquiry, a couple of months ago, his father had had a fainting episode after running, but had attributed this to dehydration. Your patient admits that he has had some episodes of dizziness and palpitations during track practice, for which he took breaks, but he has never fainted or had any chest pain. He has a normal CXR and cardiovascular examination.
What changes on his ECG would be most worrisome?
B. Premature atrial contractions
C. Prolonged QTc interval (>460 ms)
D. Sinus arrhythmia
E. Premature ventricular contractions
ANSWER ON MONDAY 10 AM
C
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ReplyDeleteThis clinical history is concerning for a cardiac-cause for syncope (with his family history of sudden death and his exertional dizziness). A referral to a pediatric cardiologist is warranted.
ReplyDeleteLong QT syndrome is a cause of ventricular arrhythmias and sudden death and would be the most worrisome of these findings. All first-degree relatives of a child with a long QTc interval should be screened by a cardiologist. First-degree AV block, premature atrial contractions, sinus arrhythmia, and premature ventricular contractions can be seen in normal children.
SO CORRECT ANSWER IS 'C'