Guideline cutoffs
International consensus guidelines differ on the degree of QT prolongation required to diagnose LQTS. The European Society of Cardiology recommends that, with or without symptoms or other investigations, LQTS can be diagnosed if the corrected QT interval is longer than 480ms. They recommend that a diagnosis can be considered in the presence of a QTc of greater than 460 ms if unexplained syncope has occurred. The Heart Rhythm Society guidelines are more stringent, recommending QTc cutoff of greater than 500 ms in the absence of other factors that prolong the QT, or greater than 480 ms with syncope. Both sets of guidelines agree that LQTS can also be diagnosed if an individual has a Schwartz score of greater than 3 or if a pathogenic genetic variant associated with LQTS is identified, regardless of QT interval. Treatment
Those diagnosed with LQTS are usually advised to avoid drugs that can prolong the QT interval further or lower the threshold for TDP, lists of which can be found in public access online databases. In addition to this, two intervention options are known for individuals with LQTS: arrhythmia prevention and arrhythmia termination. Arrhythmia prevention
Arrhythmia suppression involves the use of medications or surgical procedures that attack the underlying cause of the arrhythmias associated with LQTS. Since the cause of arrhythmias in LQTS is early afterdepolarizations (EADs), and they are increased in states of adrenergic stimulation, steps can be taken to blunt adrenergic stimulation in these individuals. These include administration of beta receptor blocking agents, which decreases the risk of stress-induced arrhythmias.
Valsalva retinopathy is a form of retinopathy due to retinal bleeding secondary to rupture of retinal vessels caused by intrathoracic or intra-abdominal pressure due to physical activities. It can occur in any person irrespective of age, gender, race or health status. Pathophysiology
Valsalva retinopathy is a form of sub-retinal, sub-hyaloid or sub-internal limiting membrane hemorrhage occur due to rupture of retinal vessels caused by a strenuous physical activity. Physical exertion like weight lifting and aerobic exercise, coughing, sneezing, straining at stool, vomiting, sexual intercourse, pregnancy, asthma, blowing up balloons, blowing musical instruments, cardiopulmonary resuscitation or compression injuries may cause sudden increase in intrathoracic or intra-abdominal pressure may lead to rupture of superficial retinal blood vessels. A sudden increase in venous pressure due to intrathoracic or intra-abdominal pressure cause the small perifoveal capillaries of retina to rupture, leading to premacular hemorrhage of varying intensity. Signs and symptoms
The main symptom of valsalva retinopathy is painless sudden loss of vision. Sudden-onset floaters and central or paracentral visual field defects and nausea resulting from increased intraocular pressure are other symptoms. Diagnosis
Patients may have a history of sudden vision loss after a strenuous physical activity. Physical examination and eye examination is needed for diagnosis of valsalava retinopathy. OCT scanning can be used to identify the location of the bleeding. Complications
One of the main complications of valsalva retinopathy is vitreous hemorrhage. Epidemiology
As of 2022, there is currently no specific age, gender or racial preference noted for this retinopathy in the medical literature.