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O'Donovan CE, Skinner JR, Broadbent E. Reference frame and emotions may contribute to discrepancies in patient and clinician risk estimates in Long QT syndrome. Patient Educ Couns 2019; 102:2296-2301. [PMID: 31262672 DOI: 10.1016/j.pec.2019.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Patients and clinicians need to have similar understandings of cardiac risk, so patients can make informed decisions. The aim of this study was to assess the concordance of risk estimates between Long-QT-Syndrome (LQTS) patients and an experienced clinician. METHODS This cross-sectional study included 86 LQTS patients recruited from a clinical registry. Participants completed two questions on their risk of cardiac arrest; likelihood (1=very-unlikely to 5=very-likely), and chance (%), and an experienced clinician computed the same based on risk factors. RESULTS 30% and 55% of patients had concordant perceptions with the clinician estimate on the chance and likelihood questions respectively. The patients who overestimated their risk (%) had significantly greater emotional responses and concerns about their LQTS. 22 (29%) patients reported a risk of 50% or greater, in contrast to the clinician's risk estimates not exceeding 30%. CONCLUSION Many LQTS patients had discordant risk perceptions to the clinician's. Patients and clinicians may have different frames of reference, and patients' estimates are linked with emotions. PRACTICAL IMPLICATIONS Clinicians need to take into account LQTS patients' different frame of reference when discussing risk information. This will support shared decision making.
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Affiliation(s)
- Claire E O'Donovan
- Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Jonathan R Skinner
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Private Bag 92024, Auckland, New Zealand; Department of Paediatrics Child and Youth Health, The University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Elizabeth Broadbent
- Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Auckland, New Zealand
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Hanninen M, Klein GJ, Laksman Z, Conacher SS, Skanes AC, Yee R, Gula LJ, Leong-Sit P, Manlucu J, Krahn AD. Reduced Uptake of Family Screening in Genotype-Negative Versus Genotype-Positive Long QT Syndrome. J Genet Couns 2014; 24:558-64. [PMID: 25273952 DOI: 10.1007/s10897-014-9776-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 09/12/2014] [Indexed: 01/08/2023]
Abstract
The acceptance and yield of family screening in genotype-negative long QT syndrome (LQTS) remains incompletely characterized. In this study of family screening for phenotype-definite Long QT Syndrome (LQTS, Schwartz score ≥3.5), probands at a regional Inherited Cardiac Arrhythmia clinic were reviewed. All LQTS patients were offered education by a qualified genetic counselor, along with materials for family screening including electronic and paper correspondence to provide to family members. Thirty-eight qualifying probands were identified and 20 of these had family members who participated in cascade screening. The acceptance of screening was found to be lower among families without a known pathogenic mutation (33 vs. 77 %, p = 0.02). A total of 52 relatives were screened; fewer relatives were screened per index case when the proband was genotype-negative (1.7 vs. 3.1, p = 0.02). The clinical yield of screening appeared to be similar irrespective of gene testing results (38 vs. 33 %, p = 0.69). Additional efforts to promote family screening among gene-negative long QT families may be warranted.
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Affiliation(s)
- Mikael Hanninen
- Division of Cardiology, Grey Nuns Hospital, Edmonton, AB, Canada
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Määttänen I, Hintsa T, Toivonen L, Swan H, Pulkki-Råback L, Hintsanen M, Kontula K, Keltikangas-Järvinen L. Cloninger's temperament traits and inherited long QT syndrome. J Psychosom Res 2011; 71:245-9. [PMID: 21911102 DOI: 10.1016/j.jpsychores.2011.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 03/10/2011] [Accepted: 03/29/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The long QT syndrome (LQTS) is an inherited cardiac disorder which predisposes the mutation carrier to ventricular arrhythmias that can lead to sudden death. The objective of the present study was to examine the association between the symptom status of congenital long QT syndrome mutation carriers and their temperament. METHODS The study subjects included 587 LQTS mutation carriers from the Finnish LQTS registry, and 2056 individuals from a database study, the Young Finns Study (YFS), representing general population and serving as control subjects. The LQTS subjects were divided into symptomatic (n=259) and asymptomatic (n=328) groups, according to their history of arrhythmic events. Temperament was assessed using the Cloninger's Temperament and Character Inventory (TCI), assessing novelty seeking, harm avoidance and reward dependence. RESULTS Congenital long QT syndrome mutation carriers had a higher harm avoidance (HA) than those representing the general population (2.77 vs. 2.61, p<.001, η²=0.011). Symptomatic and asymptomatic LQTS mutation carriers did not differ from one another in any of the three Cloninger's temperament traits. HA was significantly higher in women (2.72 vs. 2.54, p<0.001 η²=0.017). CONCLUSIONS LQTS mutation carriers may have higher stress proneness because of their high HA, which in turn may predispose them to the effects of environmental loading and thus increase the risk of arrhythmias.
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Affiliation(s)
- Ilmari Määttänen
- Institute of Behavioral Sciences, Psychology, University of Helsinki, Helsinki, Finland
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Abstract
OBJECTIVE To compare children with asthma to children with long-QT syndrome (LQTS) in terms of anxiety and medical fears. METHOD Forty children (25 males/15 females) with asthma and their mothers participated, along with seven children with LQTS (four males/three females) and their mothers. RESULTS Children with asthma had significantly more medical fears, fear of danger/death, and fear of minor injury and small animals compared to children with LQTS. Children with LQTS tended to have more fear of failure and criticism, and tended to keep their feelings to themselves and minimize their real feelings of anxiety. Children with LQTS had significantly more internalizing problems, and their mothers had significantly higher anxiety. CONCLUSION Fear and uncertainty can be overwhelming in LQTS. Children with LQTS do not seem to be able to share their feelings openly. Examining the psychosocial adjustment of affected children may assist professionals to help families to cope more effectively.
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Affiliation(s)
- R Michael Giuffre
- Department of Pediatrics, the Alberta Children's Hospital, The University of Calgary, Calgary, Alberta, Canada
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Nahshoni E, Weizman A, Yaroslavsky A, Toledano A, Sulkes J, Stein D. Alterations in QT dispersion in the surface electrocardiogram of female adolescents diagnosed with restricting-type anorexia nervosa. J Psychosom Res 2007; 62:469-72. [PMID: 17383499 DOI: 10.1016/j.jpsychores.2006.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 09/25/2006] [Accepted: 10/31/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE QT dispersion (QTd), defined as the difference between the longest interval and the shortest interval in the 12-lead electrocardiogram (ECG), is a measure of myocardial repolarization inhomogeneity. We assessed QTd in malnourished anorexia nervosa (AN) inpatients and following weight restoration. METHODS QTd analysis, anthropometric evaluations, and laboratory tests were carried out in 30 malnourished female adolescent AN restricting-type (AN-R) inpatients and following weight restoration. RESULTS A significant increase was found in weight/height ratio and body mass index from malnourished stage to weight restoration, paralleled by a significant decrease in QTd (70+/-16 vs. 47+/-16 ms; P<.0001). No correlations were found between ECG indices and anthropometric and laboratory measures. CONCLUSION Elevated QTd in malnourished AN-R inpatients may indicate possible cardiac autonomic imbalance and/or myocardial damage, likely corrected following weight restoration.
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Affiliation(s)
- Eitan Nahshoni
- Geha Mental Health Center, Beilinson Campus, Petah Tikva, Israel.
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Affiliation(s)
- Blair P Grubb
- Department of Medicine Health Science Campus University of Toledo Toledo, OH, USA.
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Minoretti P, Politi P, Martinelli V, Emanuele E, Bertona M, Falcone C, Geroldi D. QT interval duration in apparently healthy men is associated with depression-related personality trait neuroticism. J Psychosom Res 2006; 61:19-23. [PMID: 16813841 DOI: 10.1016/j.jpsychores.2006.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Revised: 01/09/2006] [Accepted: 01/10/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE High levels of neuroticism and low self-esteem are markers for vulnerability to depression, a condition associated with a higher risk of arrhythmias. The question as to whether these depression-related personality domains are related to cardiac repolarization (duration of QT interval) in apparently healthy men has been addressed in this study. METHODS Participants were 658 clinically healthy males who underwent a health screening programme. QT interval duration was determined in the resting 12-lead electrocardiogram using an automated analysis program. Neuroticism was assessed by the short-scale Eysenck Personality Questionnaire and self-esteem by the Rosenberg self-esteem scale. RESULTS Heart-rate corrected QT interval {QTc, formula of Bazett [Bazett HC. An analysis of time relations of electrocardiograms. Heart 1920;7:353-370]} progressively increased across quartiles of neuroticism ratings. By contrast, no differences in QTc were observed across different degrees of self-esteem. A multivariate regression analysis showed that neuroticism was a statistically significant, independent predictor of QTc duration. CONCLUSION After adjustment for potential confounders, neuroticism scores independently predicted QT interval duration in apparently healthy men. These findings highlight the possibility that higher arrhythmic risk could be present not only in patients with clinical depression but also in depression-prone, otherwise healthy individuals.
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Affiliation(s)
- Piercarlo Minoretti
- Interdepartmental Center for Research in Molecular Medicine (CIRMC), University of Pavia, Viale Taramelli, 24, I-27100 Pavia, Italy
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Abstract
PURPOSE Congenital long QT syndrome (LQTS) affects an estimated 1 in 5,000 persons, is characterized by QT interval prolongation, and has a clinical presentation ranging from asymptomatic longevity to sudden death in the young as the initial event. The purpose of this study was to describe the experiences of parents who have a child or children with LQTS. Information from parents of children with this diagnosis can provide insight to healthcare providers who care for these families. DATA SOURCES The literature reveals that very little is known about the psychosocial aspects of this potential sudden death syndrome. This was a secondary analysis of a 2002 qualitative phenomenological primary study done to explore fear of death and quality of life for 58 patients with LQTS. The secondary study analyzed responses derived from 31 parents of children with LQTS. CONCLUSIONS We speculated this far-reaching clinical spectrum would arouse fear and uncertainty for a parent of a child with LQTS. Results of the study revealed that parents with young children described fear of their children dying and strategies they used to manage their fear, as well as frustrations about lack of knowledge of LQTS among healthcare providers. When the diagnosis of LQTS is established during adolescence, the impact on the lives of children and their families is more significant. IMPLICATIONS FOR PRACTICE In order to support families experiencing the stress of living daily with someone with LQTS, healthcare providers including nurse practitioners need a better understanding of the symptoms, diagnosis, management, and lifestyle implications of LQTS. Further studies are needed to understand the long-term psychosocial effects of children on beta-blockers, children with implantable cardioverter defibrillators, and children, adolescents, and young adults who survive a sudden death event.
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Affiliation(s)
- Monica M Farnsworth
- Division of Education and Professional Development, Mayo Clinic, Rochester, Minnesota 55902, USA.
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Hendriks KSWH, Grosfeld FJM, van Tintelen JP, van Langen IM, Wilde AAM, van den Bout J, ten Kroode HFJ. Can parents adjust to the idea that their child is at risk for a sudden death?: Psychological impact of risk for long QT syndrome. Am J Med Genet A 2005; 138A:107-12. [PMID: 16149070 DOI: 10.1002/ajmg.a.30861] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Can a parent adjust to the idea that its child is at risk for a sudden death? This question is raised by a diagnostic procedure in which children were tested for an inherited Long QT Syndrome (LQTS). This potentially life-threatening but treatable cardiac arrhythmia syndrome may cause sudden death, especially in children and young adults. The long-term psychological effects are described for parents whose children were tested for inherited LQTS. The adverse short-term impact of such testing has been described previously. The goal of this investigation is to determine whether this distress endures. Thirty-six parents completed measures of psychological distress. With the twenty-four parents of carrier children, a semi-structured interview was held 18 months after DNA disclosure. Parents of carrier children reported more distress than parents of non-carrier children. Parents of carrier children remained vulnerable to high levels of distress; up to one-third of these parents showed clinically relevant high levels of distress. High levels of distress were reported by parents of carrier children who (1) were highly distressed at previous assessments, (2) were familiar with the disease for a longer time, (3) had experienced a sudden death in the family, (4) were lesser educated, and who (5) were unsatisfied with the given information. Parents were particularly concerned about possible hazardous behavior during puberty. We conclude that the continuous threat of developing LQTS symptoms despite prophylactic treatment affected the psychological well-being of the parents for a long time. In light of the tempetuous developments in the areas of cardiac genetics, periodical information on new insight and developments may act as a buffer for the parents' (growing) concerns about their child's inherited disorder.
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Affiliation(s)
- Karin S W H Hendriks
- Department of Medical Psychology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Abstract
The case of a 73-year-old male with delusions of parasitosis (DP) is presented. He complained about severe itching of the limbs and the genital region as well as abnormal body and pubic hair that he believed to be parasites. The symptoms occurred over the course of several years together with severe heart diseases (New York Heart Association class III, atrial fibrillation, tricuspid regurgitation) and chronic edema of the lower leg. The pruritus was also based on chronic, self-induced skin lesions due to aggressive disinfection and tearing out of body hair. After ruling out true infection, a multimodal DP therapy was initiated. Instead of the standard neuroleptic drug pimozide, olanzapine was used because of its better tolerability in patients with increased cardiac risk (i.e., borderline prolonged QTc time). At discharge, the DP had partially remitted. Substantial improvement in the heart and skin diseases under specific treatment contributed substantially to the success of the therapeutic regimen. This case hints at (1) the effectiveness of olanzapine in DP and (2) the importance of general medical conditions in the therapeutic approach to DP.
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Paavonen KJ, Swan H, Piippo K, Hokkanen L, Laitinen P, Viitasalo M, Toivonen L, Kontula K. Response of the QT interval to mental and physical stress in types LQT1 and LQT2 of the long QT syndrome. Heart 2001; 86:39-44. [PMID: 11410559 PMCID: PMC1729799 DOI: 10.1136/heart.86.1.39] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study and compare the effects of mental and physical stress on long QT syndrome (LQTS) patients. DESIGN Case-control study. MAIN OUTCOME MEASURES QT intervals were measured from lead V3. Serum potassium and plasma catecholamine concentrations were also monitored. PATIENTS 16 patients with type 1 LQTS (LQT1), 14 with type 2 LQTS (LQT2), both groups asymptomatic, and 14 healthy control subjects. INTERVENTIONS Three types of mental stress tests and a submaximal exercise stress test. RESULTS Heart rate responses to mental stress and exercise were similar in all groups. During mental stress, the mean QT interval shortened to a similar extent in controls (-29 ms), LQT1 patients (-34 ms), and LQT2 patients (-30 ms). During exercise, the corresponding QT adaptation to exercise stress was more pronounced (p < 0.01) in healthy controls (-47 ms) than in LQT1 (-38 ms) or LQT2 patients (-38 ms). During exercise changes in serum potassium concentrations were correlated to changes in QT intervals in controls, but not in LQTS patients. LQT1 and LQT2 patients did not differ in serum potassium, catecholamine or heart rate responses to mental or physical stress. CONCLUSIONS QT adaptation to mental and exercise stress in healthy people and in patients with LQTS is different. In healthy people QT adaptation is more sensitive to physical than to mental stress while no such diverging pattern was seen in asymptomatic LQTS patients.
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Affiliation(s)
- K J Paavonen
- Department of Medicine, University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland
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Hundertmark JD. Iatrogenic anxiety disorder related to failure of implantable defibrillator. Gen Hosp Psychiatry 2001; 23:166-7. [PMID: 11447986 DOI: 10.1016/s0163-8343(01)00132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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ten Kroode HF, van Langen IM, Hendriks KS, van Tintelen JP, Grosfeld FJ, Wilde AA. [Long QT-interval syndrome and investigation of heritability: psychological reactions in three generations in one family]. Ned Tijdschr Geneeskd 2000; 144:995-9. [PMID: 10858789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
DNA diagnostics were carried out in a family after the long QT interval syndrome had been diagnosed in one of its members. The psychic reactions to this testing were different from those seen in other hereditary diseases such as Huntington's disease. This was probably due to the sudden and unexpected occurrence of the arrhythmia. The family members in whom clinical and DNA diagnostics gave purely negative findings were not relieved, owing to solidarity with the affected relatives. Their partners did not understand this response. The anxiety and concern of the gene carriers had nothing to do with their own health status but with that of their carrier children. These parents were in need of educational counselling and advice. The results of clinical and DNA diagnostics affected the family relationships: in carriers the feeling of closeness grew, while the non-carriers were afraid of loss of family closeness.
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Affiliation(s)
- H F ten Kroode
- Universitair Medisch Centrum, afd. Medische Psychologie, Utrecht
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Abstract
A 17-year-old male with anorexia nervosa developed atypical prolongation of his corrected QT interval (QTc) when placed on isoproterenol for profound sinus bradycardia. His QTc normalized after the infusion was discontinued. Autonomic imbalance may explain the observed QTc lengthening. Because bradycardia associated with weight loss in anorexia is usually a physiologic adaptation and rarely symptomatic, aggressive chronotropic therapy may be not only unwarranted, but potentially deleterious.
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Affiliation(s)
- J P Harris
- Department of Pediatrics, University of Rochester Medical Center, New York 14642
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Huang MH, Ebey J, Wolf S. Manipulating the QT interval of the ECG by cognitive effort. Pavlov J Biol Sci 1989; 24:102-8. [PMID: 2771455 DOI: 10.1007/bf02701925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abnormal prolongation of the QT interval of the ECG has been reported to indicate a hazard of sudden arrhythmic death. Therefore, with the aid of biofeedback from a newly devised instrument capable of measuring and recording the QT interval of the ECG in real time, ten healthy subjects, aided by biofeedback, attempted to shorten and also to lengthen QT. Although the changes achieved were relatively small, the ten subjects as a group were successful in both shortening and lengthening QT at the 0.01 level of significance. The degree of success varied, however, from person to person and from time to time in the same individual. If the findings reported here can be applied more generally to patients at risk for sudden death, and if biofeedback effects can be made to persist without reinforcement, it or other cognitive techniques may prove clinically useful for shortening QT.
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Affiliation(s)
- M H Huang
- Totts Gap Medical Research Laboratories, Bangor, Pennsylvania 18013
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Abstract
The relationship of emotional stress to the duration of the QT interval of the electrocardiogram (which contains the period of repolarization of the myocardium) was explored because QT prolongation has been shown under some circumstances to carry a risk of potentially fatal cardiac arrhythmia. A thoroughly studied case of repeated serious and ultimately fatal arrhythmia which occurred in a setting of overwhelming family and personal stress and which was preceded by marked prolongation of the QT interval prompted an experimental study of the behavior of the QT interval during stressful interviews. The subjects were 17 men and women ranging in age from 26 to 74. The experimental sessions included: 1) a period of inactivity with the subject sitting alone, 2) a period of "neutral" discussion, 3) a period of dwelling on a presumed stressful topic, followed by 4) a period of reassurance. Heart rate, respiration, arterial pressure, and the electrocardiogram were recorded throughout the four intervals together with a real time tracing of the QT interval of the electrocardiogram made by a computerized instrument recently devised by one of us (J.E.). Most of the subjects reacted to the stressful discussion with anger and resentment that was associated with shortening of QT. Two of them, however, who reacted with dejection and a feeling of being overwhelmed, displayed lengthening of QT. The QT changes were generally not linked to changes in heart rate.
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Affiliation(s)
- M H Huang
- Totts Gap Medical Research Laboratories, Inc., Bangor, Pennsylvania 18013
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