Knowledge could save a child's life.

Often we will read about some young kid who appears otherwise healthy dropping dead on the football field, or on the basket ball court. And even though there can be many reasons for this phenomenon, one reason is Long QT Syndrome. It is estimated that 1 in 7000 children have this syndrome, and there may actually be more, as the disease can go undetected. One reason the disease goes undetected is because an EKG is not done routinely as a baseline, and at milestones in a child's life. The disease is inherited, and so, if a child has the disease, there is a possibility that an adult parent has it. There are many types of Long QT. But either the disease or the tendency to develop it is inherited.

Long QT syndrome is the result of defects in the calcium channels in the heart which prolong the time it takes for the heart to recharge after a beat. Below is an electrocardiogram interval that depicts the electrical activity of the heart.

(I am adding an image of an EKG below, Note the QT interval.)

A normal time of the re-polarization of the heart is < than .40 milliseconds -. Intervals above .50 milliseconds are diagnostic. And intervals of .55 milliseconds and beyond, are perilously long and could lead to a fatal arrhythmia called Torsade De Pointes.

The disease can be asymptomatic, or, the patient may suffer from unexplained dizzy spells. When ever a child or an adult has dizzy spells, an EKG should be done to rule out this disease.

Many of the inherited types of long QT are associated with deafness and other congenital abnormalities with the exception of LQT 1, the most common type. And so all children who are born deaf should get an electrocardiogram. As well as any child born with skeletal deformities. Or other birth defects.

But as stated: there may be no birth defects present and the child or adult may develop the disease as a response to a medication (the tendency to develop the problem with medications though, is genetic – the parents may not have the problem, but should get an EKG if the child is diagnosed.)

Medications that may trigger a long QT problem include the following:

Medications that may aggrivate acquired long QT syndrome are listed here too, and there are more meds listed at Arizona Certs from the links below:

• Antibiotics (tetracycline in particular)
  

• Antidepressants(SSRI, MAOI, tetra cyclics, and tricyclics)
  

• Anti fungals

• Antihistamines
  

• Diuretics

• Heart medications

• Lipid-lowering medications

• Oral hypoglycemics (for diabetes)

• Psychotropic medications(serequel, and other neuroleptics can both trigger the disease in some people, or aggrivate it.)

For a full list of contrainicated or precipitating meds go here:

http://www.azcert.org/medical-pros/drug-lists/drug-lists.cfm

With the increased number of children placed on antidepressants, it would be wise to get a baseline EKG before starting the medication, and another after a blood level is achieved, the medication should be stopped if cardiac symptoms develop - funny sensations in the chest "flip-flops. or dizziness occurs. And certainly any child put on Ritalin or medications that have an effect on the heart rate should be checked with EKG before the med is started, and several times while on the medication...the reason being, that if Ritilan or Adderal is given to a child with long QT, there is increased risk of an arrhythmia.

Ways to deal with long QT: Diagnosis and Treatment:

There is some difficulty diagnosing this disease in time because insurance companies do not do EKG routinely. But, the parent does have the authorityto express concerns based on education about the disease to their doctor. Parents can argue for a baseline EKG for their child. They can petition their insurance companies and write legislators to mandate milestone EKG's.

EKG should be part of a routine physical for any child. A child should have an EKG before starting any vigorous sports programs. Coaches should require them before starting athletics. If need be, a parent can pay out of pocket, and in the case of sports, or if the child is starting a psychotropic medication, they should.get a baseline EKG.

My child had a long QT interval after an overdose of Celexa. In the emergency room an EKG was done but ironically the cardiologist who read his EKG missed his long QT interval, exactly what you look for in overdose of SSRI medications. He did not notice the QT interval was going long. It was one year later- the reading was taken and this problem was picked up.,And, because we don't have a baseline EKG for comparison - we don't know if the Celexa over dose caused it. We have to assume it did, and avoid it's use because it is on the list for triggering the disease, or exacerbating it.Funnly enough, when searching for a prior EKG record, we found out EKG was not done prior to two myringotomy surgeries...(tubes in the ears to cope with chronic ear infections placed in the drum.) So a word of advice, get a your child a baseline EKG.

Secondly, if the disease is diagnosed - educate yourself. There are many resources on the Internet. The disease is treatable with beta blockers and in the worst case, an implantable defibrillator.

Incidentally, It is also a good idea to make sure your child's school is equipped with a defibrillator, and that all staff are trained in it's use. Coaches should bring them to every game. These are our kids, and only our advocacy can protect our children.

(Gary Stone is a retired nurse and medical lab technologist)

As a post script to this article I would like to say, that only in the past 15 years have so many children been put on antidepressants and amphetamine iike drugs for ADD...And so, the 1:7000 figure for Long QT of the medication induced type might be deflated. All the data is not in. Also, when a cardiologist, as in our case, is educated enough to order an EKG, but does not look at the indices (the QTc intervals and QT intervals) we may have an ignorance problem among doctors.

Celexa in high doses will always produce a longer QT interval as will OD of  any SSRI antidepressant (prozac, lexipro) in toxic doses, but the effect is usually transient. Or..is it? Celexa and other SRRI's are known to produce suicidal ideation in some kids, and so, this med should be kept out of reach. But docs should know to look at the QT intervals in the case of overdose, and, give a beta blocker in the ER if it the interval is prolonged.

My son's doc didnt do that.

And of course. the child should be kept overnight to see if the long  interval, should it occur, resolves to normal. My son didn't attempt suicide, he was in tenth grade, and used tenth grade reasoning, that if one celexa is good, 7 must be better..kids do stupid and impulsive things...all the more reason to be careful with these meds, and if there's a problem, know what to do, even if it means educating the docs.