A 40-year-old woman is found to have a QTc interval of 520 ms on routine ECG. She has no symptoms and no family history of sudden death. According to current guidelines, what is the most appropriate initial management?

• A Implantable cardioverter-defibrillator
• B Genetic testing only, no treatment needed
• C Left cardiac sympathetic denervation
• D Beta-blocker therapy and avoidance of QT-prolonging drugs ✓

Explanation

QTc >500 ms carries significantly increased risk of torsades de pointes. For asymptomatic patients with long QT syndrome, beta-blockers (particularly nadolol or propranolol) are first-line therapy. ICD is reserved for survivors of cardiac arrest or those with syncope despite beta-blockers. Avoidance of QT-prolonging drugs and electrolyte correction are essential.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.