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Hould be suspected in any patient who has recurrent syncopal or near-syncopal spells during physical activity or emotional distress, or who has a family history of unexplained sudden death in an otherwise-healthy young person or infant. Table 2 clues to sudden arrhythmia death syndrome otherwise healthy person with: syncope, especially with exercise or severe stress family history of sudden, unexpected death (nocturnal, swimming, athletic exertion, startle response, sids) pacific rim origin (southeast asia, japan, philippines) ecg: long qt syndrome not otherwise explained, brugada sign, torsades de pointes, ventricular fibrillation sids = sudden infant death syndrome; ecg = electrocardiography. In some persons, resting ecg can detect long qt syndrome. However, prolongation of the qt interval has been minimal or absent in a substantial number of persons known to carry genetic mutations that cause long qt syndrome. If the resting ecg is nondiagnostic, ecg should be performed during exercise. Qt intervals that are borderline or normal at rest may become distinctly abnormal with exercise. Risk assessment the most common mutations related to the long qt syndrome are in three genetic loci termed lqt1 and lqt2 (potassium channel genes) and lqt3 (a sodium channel gene). Risk stratification for these patients is based on the locus, length of the qtc interval with a cutoff of d msec, and gender. In one large study,15 mutations of lqt1 were the least hazardous, with a 30 percent probability of cardiac events by age 40 years. The qtc is qt corrected for heart rate, and cardiac event was defined as syncope, cardiac arrest, or sudden death. Lqt2 and lqt3 mutations were associated with event rates approaching 50 percent. Qtc of more than cardinal msec is a risk marker for lqt1 for either gender. Men with lqt2 mutations and qtc of less than large integer msec have relatively low risk of cardiac events, whereas all women with lqt2 mutations have relatively high risk. All patients with mutations at the lqt3 locus have relatively high risk of cardiac events. Prophylactic beta-blocker therapy has been recommended for high-risk patients, and decisions may be individualized for low-risk patients. 15 treatment competitive sports carry some inherent risk in patients with long qt syndrome, because symptoms often are precipitated by physical exertion or emotion. Given the rare nature of sads, it is understandable that drug treatment recommendations are mostly anecdotal. cheap viagra cheap viagra buy viagra online cheap viagra online buy generic viagra online usa pharmacy viagra for sale buy generic viagra on line buy generic viagra viagra for sale cheap viagra The goal of therapy is the resolution of symptoms and, in many cases, abnormalities on ecg normalize after treatment. Different ion channel gene mutations are targeted with different medications. Beta blockers and potassium supplements are among the drugs used to treat long qt syndrome. Permanent pacemakers or automatic implantable defibrillators als.
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