Many people with long QT syndrome don't have any signs or symptoms. They may be aware of their condition only from results of an electrocardiogram (ECG) performed for an unrelated reason, because they have a family history of long QT syndrome or because of genetic testing results.
For people who do experience signs and symptoms of long QT syndrome, the most common long QT symptoms include:
- Fainting. This is the most common sign of long QT syndrome. In people with long QT syndrome, fainting spells (syncope) are caused by the heart temporarily beating in an erratic way. These fainting spells may happen when you're excited, angry, scared or during exercise. Fainting in people with long QT syndrome can occur without warning, such as losing consciousness after being startled by a ringing telephone.
Signs and symptoms that you're about to faint include lightheadedness, heart palpitations, irregular heartbeat, weakness and blurred vision. However, in long QT syndrome, such warning signs before fainting are unusual.
- Seizures. If the heart continues to beat erratically, the brain becomes increasingly deprived of oxygen. This can then cause generalized seizures.
- Sudden death. Normally, the heart returns to its normal rhythm. If this doesn't happen spontaneously and paramedics don't arrive in time to convert the rhythm back to normal with an external defibrillator, sudden death will occur.
Signs and symptoms of inherited long QT syndrome may start during the first months of life, or as late as middle age. Most people who experience signs or symptoms from long QT syndrome have their first episode by the time they reach age 40.
Rarely, signs and symptoms of long QT syndrome may occur during sleep or arousal from sleep.
When to see a doctor
You should see your doctor if you suddenly faint during physical exertion or emotional excitement or after use of a new medication.
Because long QT syndrome can occur in families, see your doctor to be tested for long QT syndrome if a first-degree relative (parent, sibling or child) has been diagnosed with long QT syndrome.
Your heart beats about 100,000 times a day to circulate blood throughout your body. To pump blood, your heart's chambers contract and relax. These actions are controlled by electrical impulses created in the sinus node, a group of cells in the upper right chamber of your heart. These impulses travel through your heart and cause it to beat.
After each heartbeat, your heart's electrical system recharges itself in preparation for the next heartbeat. This process is known as repolarization. In long QT syndrome, your heart muscle takes longer than normal to recharge between beats. This electrical disturbance, which often can be seen on an electrocardiogram (ECG), is called a prolonged Q-T interval.
Prolonged Q-T interval
An electrocardiogram (ECG, also called an EKG) measures electrical impulses as they travel through your heart. Patches with wires attached to your skin measure these impulses, which are displayed on a monitor or printed on paper as waves of electrical activity.
An ECG measures electrical impulses as five distinct waves. Doctors label these five waves using the letters P, Q, R, S and T. The waves labeled Q through T show electrical activity in your heart's lower chambers.
The space between the start of the Q wave and the end of the T wave (Q-T interval) corresponds to the time it takes for your heart to contract and then refill with blood before beginning the next contraction.
By measuring the Q-T interval, doctors can tell whether it occurs in a normal amount of time. If it takes longer than normal, it's called a prolonged Q-T interval. The upper limit of a normal Q-T interval takes into account age, sex, and regularity and speed of the heart rate.
Long QT syndrome results from abnormalities in the heart's electrical recharging system. However, the heart's structure is normal. Abnormalities in your heart's electrical system may be inherited or acquired due to an underlying medical condition or a medication.
Inherited long QT syndrome
At least 12 genes associated with long QT syndrome have been discovered so far, and hundreds of mutations within these genes have been identified. Mutations in three of these genes account for about 70 to 75 percent of long QT syndrome cases.
Doctors have described two forms of inherited long QT syndrome:
- Romano-Ward syndrome. This more common form occurs in people who inherit only a single genetic variant from one of their parents.
- Jervell and Lange-Nielsen syndrome. Signs and symptoms of this rare form usually occur earlier and are more severe than in Romano-Ward syndrome. It's seen in children who are born deaf and have long QT syndrome because they inherited genetic variants from each parent.
Additionally, scientists have been investigating a possible link between SIDS and long QT syndrome and have discovered that about 10 percent of babies with SIDS had a genetic defect or mutation for long QT syndrome.
Acquired long QT syndrome
More than 50 medications, many of them common, can lengthen the Q-T interval in otherwise healthy people and cause a form of acquired long QT syndrome known as drug-induced long QT syndrome.
Medications that can lengthen the Q-T interval and upset heart rhythm include certain antibiotics, antidepressants, antihistamines, diuretics, heart medications, cholesterol-lowering drugs, diabetes medications, as well as some antifungal and antipsychotic drugs.
People who develop drug-induced long QT syndrome may also have some subtle genetic defects in their hearts, making them more susceptible to disruptions in heart rhythm from taking drugs that can cause prolonged Q-T intervals.
People at risk of long QT syndrome include:
- Children, teenagers and young adults with unexplained fainting, unexplained near drownings or other accidents, unexplained seizures, or a history of cardiac arrest
- Family members of children, teenagers and young adults with unexplained fainting, unexplained near drownings or other accidents, unexplained seizures, or a history of cardiac arrest
- First-degree relatives of people with known long QT syndrome
- People taking medications known to cause prolonged Q-T intervals
- People with low potassium, magnesium or calcium blood levels — such as those with the eating disorder anorexia nervosa
Long QT syndrome often goes undiagnosed or is misdiagnosed as a seizure disorder, such as epilepsy. However, long QT syndrome may be responsible for some otherwise unexplained deaths in children and young adults. For example, an unexplained drowning of a young person may be the first clue to inherited long QT syndrome in a family.
Prolonged Q-T intervals may never cause any problems. However, physical or emotional stress may "trip up" a heart susceptible to prolonged Q-T intervals and cause the heart's rhythm to spin out of control, triggering life-threatening, irregular heart rhythms (arrhythmias) including:
- Torsades de pointes — 'twists of the points.' This arrhythmia is characterized by your heart's two lower chambers (ventricles) beating fast, making the waves on an ECG monitor look twisted. When this arrhythmia occurs, less blood is pumped out from your heart. Less blood then reaches your brain, causing you to faint suddenly and, often, without any warning.
If a torsades de pointes episode is short — lasting less than one minute — your heart can correct itself seconds later, and you regain consciousness on your own. However, if a torsades de pointes episode persists, it can lead to a life-threatening arrhythmia called ventricular fibrillation.
- Ventricular fibrillation. This condition causes the ventricles to beat so fast that your heart quivers and effectively ceases pumping blood. Unless your heart is shocked back into a normal rhythm by a device called a defibrillator, ventricular fibrillation can lead to brain damage and death. It's thought that long QT syndrome may explain some cases of sudden death in young people who otherwise appear healthy.
If you have inherited long QT syndrome, be careful about which medications you take. Some medications — including certain appetite suppressants, decongestants and common antibiotics, such as erythromycin — may trigger dangerous heart rhythms. Ask your doctor what you can and can't take safely. Street drugs, such as cocaine and amphetamines, pose a serious risk for people with long QT syndrome.
In addition, seek medical treatment right away for illnesses that could result in low blood-potassium levels, such as conditions that cause excessive vomiting and diarrhea. Such sicknesses could trigger an episode of long QT syndrome in people at risk. Your doctor may advise you not to take some drugs, such as diuretics, that lower blood-potassium levels.
For some people — especially older adults with long QT syndrome who haven't had signs or symptoms of the condition in decades — preventive measures may be all the treatment that's required.