Long Qt presenting in a 23 yr Old
As I mentioned previously, I try to stay in shape with an occasional pick up game of basketball at the local gym. I had seen this young, tall, lean young man before and decided to choose him for my team in a two on two game of hoops. The game began ok but after a few minutes the young man would squat all the way to the floor for a few seconds in an attempt he said to catch his breath. I am in my sixties and had no need for such efforts to catch my breath. I asked him about what he was doing and he just said, “I am a smoker, that’s all”. After he did it for the second and third times after a few minutes of only half court play I told him that it was probably not smoking but he insisted that he was OK.
After finishing the game I went to the weight room to complete my workout and began to think that this guy may have a heart problem. He did have a sort of Marfan like body habitus making me think that he had the syndrome like Abe Lincoln which can affect the heart. I inquired of the staff at the gym if they had a phone number to call this young man, but no one had one. Luckily, the very next week the guy came back to the gym and I told him what I thought and that he should see his family doctor. I said that I was doing research in heart problems and asked if he would give me his birthdate. He obliged and I also secured his phone number so that i could contact him of my findings. Upon looking at his birth date it was clear that this young man had an abnormality, more specifically he showed long qt syndrome along with a tendency to hypertension and atherosclerosis. I texted him my findings and asked him to make an appointment with his family doctor for a referral, if necessary, to see a cardiologist. He said that when school was out in May he would do so when he went home from attending the local university. I saw him a couple of weeks later and asked what his doctor said and he told me that he had an appointment with a cardiologist the next week, I was relieved at this point that something would be done to help this nice young man.
Needless to say, it did not happen. For I saw him last week in the gym again and he told me the cardiologist did an EKG and exam but found nothing but a smaller than usual artery in his right arm. He said the doctor told him his heart was completely fine. I was like, “what?” ……..No artery in his arm would make him so short of breath that he had to get on his knees to catch his breath. I was upset and told him such and that I would contact his doctor if necessary to explain the symptoms that I witnessed.
So here is my dilemma folks. This young man has an arrhythmia by my analysis. It apparently was a mild and temporary episode that he experienced that did not kill him but only caused episodic shortness of breath from the likely rapid heartbeat caused by the long qt syndrome. It was mild enough to not even cause syncope, but only shortness of breath and easy fatigue. By the time he got to the cardiologist the temporary episode was over. When I saw him this last time, he had no episodes of shortness of breath nor easy fatigue. However if you look at the literature and research findings, this is an all too common occurrence with long qt and even other arrhythmias. They are episodic in nature. They will not always show on an EKG. The cardiologist should have known this but seemed to be cavalier in his attitude about the situation. Perhaps the young man was not clear or straightforward in his history to the doctor. But a holter monitor or even a stress test could have been performed. Only an Ekg was done. This was not adequate.
I am now in the position of having to come up with an alternative for the young man because he could be a statistic of sudden death if nothing is done. I am considering contacting the cardiologist or another one to evaluate the student. But here is the big problem in medicine and cardiology. The disease is intermittent and they wont recognize this. Was the cardiologist hamperd by the student’s insurance company who would not pay for further evaluation if the EKG and exam are negative? The literature is clear on this that the disease is intermittent in nature. My work says that it can be diagnosed even if the Ekg is negative.
Any internist or cardiologist who reads this and is willing to intervene and perhaps save this young man’s life would be greatly appreciated. I am in talks with a medical school about my research but as yet have had no response.
What is wrong with people? I am becoming depressed and frustrated. Somebody do something. I am trying to do my best here. Maybe a lawyer is out there reading this and will try to do something legally in this matter. If this young man dies, the cardiologist should be liable. I will partner with any lawyer if needed who is interested in bringing known cases of sudden death that were not properly diagnosed to the court of law for justice in this matter. Something surely must be done.