Promporn Suksaranjit, MD

To the Editor: We read with great interest the article by Drs. Al Maluli and Meshkov on short QT syndrome in the January 2013 issue.¹ We are wondering whether Holter monitoring and giving a beta-blocker can help in the diagnosis of this syndrome.

Compared with the normal population, patients with short QT syndrome have less variation of the QT interval in relation to the change in heart rate. This will result in misinterpretation of the corrected QT interval with a faster heart rate and subsequently false-negative diagnosis of this possibly fatal syndrome. Holter monitoring can be helpful in this situation because it allows measurement of the corrected QT interval during a period of slower heart rate, such as sleep.

Bjerregaard² mentioned the use of a beta-blocker to slow the heart rate when measuring the corrected QT interval. According to the diagnostic criteria, a shorter corrected QT interval correlates with a higher probability of short QT syndrome. Using the above measures may reveal the true corrected QT interval and improve the diagnostic accuracy of short QT syndrome in patients with a rapid heart rate.

To the Editor: We read with great interest the article by Drs. Al Maluli and Meshkov on short QT syndrome in the January 2013 issue.¹ We are wondering whether Holter monitoring and giving a beta-blocker can help in the diagnosis of this syndrome.

Compared with the normal population, patients with short QT syndrome have less variation of the QT interval in relation to the change in heart rate. This will result in misinterpretation of the corrected QT interval with a faster heart rate and subsequently false-negative diagnosis of this possibly fatal syndrome. Holter monitoring can be helpful in this situation because it allows measurement of the corrected QT interval during a period of slower heart rate, such as sleep.

Bjerregaard² mentioned the use of a beta-blocker to slow the heart rate when measuring the corrected QT interval. According to the diagnostic criteria, a shorter corrected QT interval correlates with a higher probability of short QT syndrome. Using the above measures may reveal the true corrected QT interval and improve the diagnostic accuracy of short QT syndrome in patients with a rapid heart rate.

To the Editor: We read with great interest the article by Drs. Al Maluli and Meshkov on short QT syndrome in the January 2013 issue.¹ We are wondering whether Holter monitoring and giving a beta-blocker can help in the diagnosis of this syndrome.

Compared with the normal population, patients with short QT syndrome have less variation of the QT interval in relation to the change in heart rate. This will result in misinterpretation of the corrected QT interval with a faster heart rate and subsequently false-negative diagnosis of this possibly fatal syndrome. Holter monitoring can be helpful in this situation because it allows measurement of the corrected QT interval during a period of slower heart rate, such as sleep.

Bjerregaard² mentioned the use of a beta-blocker to slow the heart rate when measuring the corrected QT interval. According to the diagnostic criteria, a shorter corrected QT interval correlates with a higher probability of short QT syndrome. Using the above measures may reveal the true corrected QT interval and improve the diagnostic accuracy of short QT syndrome in patients with a rapid heart rate.

To the Editor: We thank Drs. Venkatachalam and Rimmerman¹ for their Clinical Picture article, “Electrocardiography in aortic regurgitation: It’s in the details,” in the August 2011 issue. This was very interesting, as usual for the Cleveland Clinic Journal of Medicine.

The maxim that “a negative U wave is never normal,” first noted about 50 years ago, still holds true. However, the authors’ statement on page 506—ie, that a negative U wave indicates structural heart disease—is too restrictive, since ischemia is not always due to a structural problem. Functional ischemia from excess demand, such as from tachycardia, sepsis, or gastrointestinal bleeding, can also cause negative U waves.^2,3 The broader comment in the “sidebar” on page 505 could be considered to include demand ischemia, but for clarity, it would be helpful to state this explicitly.

To the Editor: We thank Drs. Venkatachalam and Rimmerman¹ for their Clinical Picture article, “Electrocardiography in aortic regurgitation: It’s in the details,” in the August 2011 issue. This was very interesting, as usual for the Cleveland Clinic Journal of Medicine.

The maxim that “a negative U wave is never normal,” first noted about 50 years ago, still holds true. However, the authors’ statement on page 506—ie, that a negative U wave indicates structural heart disease—is too restrictive, since ischemia is not always due to a structural problem. Functional ischemia from excess demand, such as from tachycardia, sepsis, or gastrointestinal bleeding, can also cause negative U waves.^2,3 The broader comment in the “sidebar” on page 505 could be considered to include demand ischemia, but for clarity, it would be helpful to state this explicitly.

To the Editor: We thank Drs. Venkatachalam and Rimmerman¹ for their Clinical Picture article, “Electrocardiography in aortic regurgitation: It’s in the details,” in the August 2011 issue. This was very interesting, as usual for the Cleveland Clinic Journal of Medicine.

The maxim that “a negative U wave is never normal,” first noted about 50 years ago, still holds true. However, the authors’ statement on page 506—ie, that a negative U wave indicates structural heart disease—is too restrictive, since ischemia is not always due to a structural problem. Functional ischemia from excess demand, such as from tachycardia, sepsis, or gastrointestinal bleeding, can also cause negative U waves.^2,3 The broader comment in the “sidebar” on page 505 could be considered to include demand ischemia, but for clarity, it would be helpful to state this explicitly.