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Formidable forme fruste of long QT syndrome in a 24 year old female with an eating disorder
  • Sita Sai Garapati
Sita Sai Garapati
NewYork-Presbyterian Brooklyn Methodist Hospital

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Long QT syndrome (LQTS) is a myocardial repolarization disorder characterised by a prolonged QT interval ( >470 milliseconds for men and >480 milliseconds for women) on the electrocardiogram 1. It can be congenital or acquired. Due to the incomplete penetrance and variable expressivity of genes, this classification is not binary and hence confers different risks. Acquired LQTS may represent a forme fruste of previously clinically concealed congenital LQTS. Eating disorders affect 9% of the population worldwide 2 and carry with them one of the highest mortality rate of any other psychiatric disorder (second to opioid overdose) 2. Women have a 8.4% prevalence of weighted means for lifetime eating disorders, compared to 2.2% in men 3. Since the pandemic began, there has been a surge in eating disorders according to the national eating disorders association. Most of these are due to sudden cardiac arrest due to arrhythmias 4 or suicide. Multiple factors could prolong the QT interval in such conditions, predisposing patients to malignant ventricular arrhythmias like torsade de pointes. In eating disorders, electrolyte abnormalities (hypokalemia and hypomagnesemia) can be caused due to restrictive eating, purging/ self induced vomiting, refeeding syndrome, laxative and diuretic abuse. Many antidepressant medications used in treatment of the same could also cause QT prolongation. Patients with severe eating disorders may also experience thiamine deficiency or ipecac induced cardiomyopathy 5, which could increase the risk of fatal arrhythmias. If an inherited predisposition for LQTS is present, it becomes diagnostically apparent when exposed to multiple inciting factors like these and could manifest in a lethal way.