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Thank you for the excellent article, "Too Fast, Too Slow, Too Ugly: Dysrhythmias That Every Nurse Should Recognize" (September 2009).* I'd like to add that every nurse should also recognize an important risk factor of dysrhythmias: a prolonged QTc interval. A prolonged QTc is diagnostic for long QT syndrome (LQTS), which is associated with sudden arrhythmic death syndrome (SADS). SADS accounts for thousands of deaths every year, mostly of young people.

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Patients who have seizures or syncope should be evaluated with a standard 12-lead ECG. LQTS, which can be caused by genetic factors, certain drugs, or electrolyte imbalances, can usually be treated effectively once it's identified.


When my daughter had surgery at age 9, her cardiac monitor rhythm strip clearly showed a prolonged QT interval, but the healthcare staff and I failed to notice it despite our training. At age 15, after having a syncopal episode at school, my daughter was diagnosed and treated for LQTS. I shudder to think that 30% of those with LQTS experience cardiac arrest as their first sign.


While I'm on my soapbox, the SADS Foundation recommends that every school have an automated external defibrillator. Does yours?




Palouse, Wash.


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