QTc interval

Okay...I've got myself really worked up. (actually shaking while I type this ).

I had my first (and only recorded) AFib episode in November 2018.

My BP was high (and had been for awhile, I was just ignoring it and hoping it would go away).

I was put on a beta blocker and amlodopine. (Bisoprolol-HCTZ 10-.6.25 mg and Amlododipine Besylate 5mg. I took Eliquis for 3 months,until I saw the electrophysiologist, who took me off because my CHADS score was 1 (for the HP).

So, for the last 3 years, I have only been to the cardiologist twice (one was Electrophysiology) in person and then last year virtual.

I just went in April and during that time they took an EKG. Also, during the visit, I asked if there was any way they could lower my meds since my energy level had reduced, I was finding it hard to lose weight, etc. He cut my beta blocker in half (5-6.25). My BP runs about 100/60, pulse 50-55.

Also, he prescribed me a heart monitor for 30 days, since I am NOT on blood thinners and he wanted to make sure that I was not having Afib when I was not aware (sleeping maybe). I can assure you I feel every beat, I am hyper sensitive and I do feel skipped beats. He also wanted to see if the Eliquis should be added back (I am now age 66.)

Anyway, I'm wearing the monitor now.

So....my question, I just checked my online test resultf from the doctor visit and saw that my QTc interval was 472.

I googled and now I'm freaking because I see very scary possibilities (seizure, sudden death, etc.)

Could nervousness or stress cause a prolonged QTc? I was very nervous at my visit. They had me laving very flat, etc, but I HATE going to the doctor.

Please calm me down Just FYI, the last couple of years have been stressful. My 2 younger sisters have both passed away. One unexpectedly from Covid and the other from early onset dementia, after battling it for 8 years (I was helping care for her).



Edited 2 time(s). Last edit at 05/02/2022 12:41PM by katesshadow.

Relax! There's a reason you didn't hear about this from a doctor, and that reason is they saw it and weren't concerned. Your QTc is slightly widened but it's still a full 30 ms away from being a threat. All that number means is you might not be able to take Tikosyn and possibly sotalol. Otherwise, it's meaningless and you are not in danger.

Thank you so much!

So, what exactly does that even mean?

Does reducing the beta blocker mg affect it? My heart rate was just so slow (average 50, sometimes dipping to 49) that the BB was zapping my energy. Exercising had become such a chore that I was hoping that reducing the mg would help.

Can I improve the QTc interval on my own?

Thank you again. .

Carey- could wrong placement of the ekg leads also affect the accuracy of the ekg? I’ve had many ekgs that the machine’s computer said abnormal and pretty alarming stuff but each and every time my local EP, ER doctor and even others said I’m fine, just human lead placement error.

So Kate- you should be ok otherwise your EP would call you up. Two of my EPs offices they repeat if they were concerned but in your case they didn’t repeat the ekg. You can always call them with your concerns so maybe call and ask. You have enough stress with your sisters passing to worry about an ekg.

So sorry about your loss.

Thank you.

I actually just went back to past EKG and found one from 2017 when I went in for a gallbladder attack. My QTc was 481...

I have found other EKGs where the QTc is much lower (439 in 2018).

I wonder if stress plays a part?

I was reading (bad I know) that calcium channel blockers might cause it, but I was not taking any meds in 2017.

All kinds of things will affect that number. Lead placement, stress, beta blockers, exercise, you name it. It's not worth worrying about and certainly not worth trying to do anything about because it's pretty much irrelevant to your health.

Almost all medical tests have "normal" ranges, and it can be alarming when you see a number that's outside the normal range, but you have to keep in mind that those are statistical norms and interpreting them is never a simple, self-contained problem. The entire patient needs to be considered. For example: I have always run low on sodium levels and low sodium is very dangerous, so it gets doctors worked up. But after about 10 years of noticing that I'm often a few points under the "normal" lower limit and I'm not dead yet, my doctors have calmed down and pay it no attention now. That's how QTc works too. You're a little bit above the statistical norm. So what? You're far from the dangerous numbers (>500), and it's extremely unlikely that will change much over your lifetime. It's just your body and the way it works.

You're okay.

Thanks again for the reassurance

I have to chime in here - I had a cardiac arrest in October due to high QTc interval, I was lucky to be in the hospital at the time due to severe breathing trouble.
My QTc was over 600 and it was the result of taking fluoxetine (Prozac). I was told by my the doctors that they do not get concerned unless it is over 500 but I have read articles that indicate lower numbers than that are dangerous.

That said, there are lists online of medications that cause the QTc interval prolongation. I am sorry I don't have the link. Prozac is on that list. I have also read studies that indicate Prozac may cause Afib as well, Amloderone is also on that list. I was prescribed Amioderone and when I asked the doctors why I was taking it they shrugged and said it works to control rythm but "for some reason - we don't know why, it does not affect QTc. BS. I stopeed taking it.

These QTc side effects mostly occur in people over 60. I was 65 with a prior heart attack and afib and still my doctor prescribed Prozac and raised the dose three times in three months which sent me to the ER, unable to breathe.
Your body changes over time. Things we could do when we were young can be dangerous after 60 and the same goes for the medications we are prescribed.

Some sites that list drugs that could potentially cause a QT prolongation. Take them “with a grain of salt” for those sites you are not fully confident with:

[www.crediblemeds.org]

[www.nps.org.au]

[litfl.com]

[www.medscape.com]

The NPS site does not list fluoxetine. or any other SSRIs, for that matter, Are they sold under different names in Australia? I would encourge people NOT to take these lists with a grain of salt.

I would probably trust this list the most. See table 2.

That is the one I found. Thank you for posting the link.

One more thought on what happened to me with the QTc interval. This just occured to me but I was in the ER for around 10 hours. During that time I had a couple of EKGs which as I recall showed hi;gh normal QTc interval, There was absolutely no warning when it jumped above 600. I felt weird so I checked my pulse and I felt it stop before I blacked out. When I was resuscitated, one of the doctors was poring over my the results from the heart moniter they had me wearing. She was really freaked out that the QTc interval had spike like that.

My point is, if this happened, what is the benefit of monitering EKGS while on these dangerous drugs? Does it alwyas come out of left field without warning? Food for thought. I am seeing a new cardiologit on the 26th who happened to be on duty at teh hospital when this happened. I will ask him and report back if anyone is interested.
BTW, they stopped giving me my Prozac immediterly nd my QTc intervl returned to normal in a few days, although still high. in my opinion.

I looked at the list and I do not take any of the drugs listed. Just 2 BP meds (bisoprolol and amlodopine)