Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint: Follow-up for Long QT syndrome (LQTS) / New symptoms concerning for LQTS (specify)
History of Present Illness:
Briefly describe the reason for this visit.
For follow-up visits, inquire about any new or worsening symptoms since the last encounter (e.g., palpitations, dizziness, syncope – fainting).
For new symptom presentations, characterize them in detail (onset, duration, setting – e.g., at rest, exertion, emotional stress).
Mention any recent triggers or events that may have caused concern (e.g., illness, medication changes, emotional stress).
Past Medical History:
Include the date of Long QT syndrome diagnosis.
Mention the specific LQTS subtype, if known (e.g., LQT1, LQT2, etc.).
List any relevant past medical history, including:
Family history of LQTS or sudden cardiac death (SCD) at a young age.
History of syncope or documented cardiac arrhythmias.
Underlying conditions that may prolong the QT interval (e.g., electrolyte imbalances, hypothyroidism).
Medications:
List all current medications, including those specifically used for LQTS management (e.g., beta-blockers).
Mention any medications that can prolong the QT interval and should be avoided (consult a QT-interval drug database).
Social History:
Inquire about tobacco use (smoking can worsen arrhythmias).
Family History:
Detail the family history of LQTS or SCD, including:
Degree of relation to affected family members.
Age of onset of cardiac events in family members.
Specific LQTS subtype in family members (if known).
Physical Exam:
Vital signs: Include temperature, pulse rate (irregular pulse may suggest arrhythmia).
Cardiovascular exam: Assess for heart murmurs or signs of heart failure (edema, jugular venous distention).
Electrocardiogram (ECG):
This is the most crucial test for LQTS diagnosis and follow-up. Mention the QT interval measurement on the ECG, corrected for heart rate (QTc interval).
Holter Monitor or Event Recorder (if used):
Mention if a Holter monitor or event recorder was used to capture any cardiac arrhythmias during a longer period.
Genetic Testing (if performed):
Mention if genetic testing was performed to identify the specific LQTS gene mutation.
Assessment:
Diagnosis: Confirm the diagnosis of Long QT syndrome and mention the specific subtype if known.
QTc interval: State the measured QTc interval and interpret its significance in the context of LQTS diagnosis and risk stratification.
Risk of arrhythmias: Briefly describe the perceived risk of cardiac arrhythmias based on the QTc interval, family history, and presence of symptoms.
Plan:
Treatment:
Outline the treatment plan based on the risk stratification and individual needs. This may include:
Beta-blockers: The cornerstone of treatment to reduce the heart rate and decrease the risk of arrhythmias.
Pacemaker implantation: May be considered in some cases to prevent bradycardia (slow heart rate) or specific arrhythmias.
Implantable cardioverter-defibrillator (ICD) placement: For high-risk patients to detect and terminate life-threatening arrhythmias with a shock.
Genetic counseling: Recommend genetic counseling for the patient and at-risk family members.
Lifestyle modifications:
Advise smoking cessation and a healthy lifestyle (diet, exercise) to reduce arrhythmia risk.
Educate the patient about avoiding medications and substances that can prolong the QT interval.
Regular follow-up: Schedule regular clinic visits and ECG monitoring to assess for changes in QTc interval or symptoms.
Education: Educate the patient about Long QT syndrome, its risks, available treatment options, and the importance of medication adherence and regular follow-up.