[SCD-FORUM] 33E RE: Young woman with LQTS. Dr. Klingenheben

[SCD Symposium]

Interesting case, I have a similar patient with postpartum VF-arrest.  
She got an ICD and hat futer TdP-VT documented. Postpartum Cardiac  
arrest is almost pathognomonic for LQT-2, as are "notched" T waves.  
My opinion is that this particular patient is at high risk for future  
events and I clearly would proceed to ICD therapy - irrespective of  
future pregnancies.
I would add a question to Prof. Priori: are there clinical data from  
the LQT registry concerning arrhythmic events during/after pregnancy  
in patients with suspected/confirmed LQT ?

Thomas Klingenheben
>

Thomas Klingenheben, MD
Assistant Professor of Medicine
Kardiologische Gemeinschaftspraxis
Alfred-Bucherer-Str. 6
D 53115  Bonn - Germany
e-mail: Klingenheben at aol.com
e-mail: Klingenheben at em.uni-frankfurt.de
Web:    www.bonn-kardiologie.de

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee

>
> First of all I would like to say "thank you" for the nice on-line  
> symposium
> on SCD.
>
> I would kindly ask Prof. Silvia Priori....worldwide famous expert  
> on LQTS
>
> Namely, the one of my patient is a 23-yo woman.....LQTS was  
> diagnosed 2
> years ago. It was 5 months after first (and the only) partum. She  
> had lost
> of conscious. QT interval in rest ECG - 515 msec, in Holter  
> monitorng....PVc
> -300/day, QT in nighttime till 600 msec, dynamicity in T-wave complex,
> postextrasystolic TU wave augmentation. Exercise test induced  
> momomorphic
> PVC (monomorphic bigeminy)......PVC disapeared totally in recovery  
> phase.
>
> Rest ECG shows notched T wave in V2-V5 so it looks like LQTS type 2.
>
> There is no evidence of SCD in her family. We started treatment with
> Beta-bloker -metoprolol until dose  3 x 75 mg (this dose is well  
> tolerated
> by her...with no syncope so far). (Nadolol is not available in  
> Poland now).
> Because she plans to have the next pregnancy. My questions are..
>
> 1) what should be the proper therapy during pregnancy ?
>
> 2) how to carry safe the patient during the delivery period ?
>
> 3) should I increase the dose of beta-bloker in post-partum period ?
>
> with best regard,
>
> Dr Piotr Kukla
> Specialistic Hospital in Gorlice
> Departament of Internal Medicine
> Gorlice, Poland

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