I have a family member who recently gave me access to their online chart to help them navigate some insurance stuff, and I saw some things that I’m concerned about, but don’t know how to gauge how concerned it’s appropriate to be. I sent emails to his PCP alerting of the situation, but I have not heard back in several days, and I’m wondering how urgent the situation is or whether it’s even too concerning.
I’m not a clinician although I work in a pretty technical field within medicine so I’m kind of an idiot savante here, and I’m hoping someone can help me get perspective on this
Person is in their 20s and has a number of illnesses from years of serious physical and mental health issues. A major problem is that he’s physically dependent on THC and also has cannabis hyperemesis syndrome, so at least 3 times a week or so he violently vomits or dry heaves and has had several ED visits for it when abdominal pain became abnormally intense
On his chart, I saw that late last year at one of his ED visits his QTc was 471 ms, which statistically put him at the 98th percentile, and close to the 500 ms threshold which I understand would be pretty serious
Since then his psychiatrist has put him on a stimulant, and my understanding is these further raise QTc.
So to me, this all starts off being somewhat concerning. But the thing that’s really throwing a scare into me is that based on his chart, he’s not reported to clinicians that he has cannabis dependence and cannabis hyperemesis syndrome, rather he reports that he smokes more pot than he should, and sometimes vomits, rather than the reality
which is that he smokes pot multiple times a day and vomits or dry heaves at least several times a week. And he is definitely physically dependent, he voluntarily detoxed once cold turkey and it was really ugly for about 48 hours.
My understanding is that a standard Valsalva against 40 mmHg produces a further QTc elevation of 30 to 40 millisecond, and the functional Valsalva caused by violent hyperemesis can transiently raise QTc by 100 or even 200 ms.
So transiently his QTC might be reaching 600 or even 700ms multiple times per week, from a baseline that’s already pretty high (and multiplies baseline risk of sudden cardiac death). And there is case literature of people suffering SCD after violent vomiting from CHS.
Meanwhile, nobody has referred him for a cardiology consult or seems too concerned about this, but they also don’t have complete information. And PCP (who has a signed release from my relative to speak directly to me) is not getting back to me regarding my attempting to add the missing information that I think could change medical decision-making. So I feel like on the one hand if his baseline QTc were 600+ he’d be bunking at the hospital for a while as they sorted this out and tried to reduce QTC and get him off of weed. But it’s only transient. But even transient QTc elongation has resulted in some number of deaths. And he has not been referred for a cardiac consult so he does not have a cardiologist.
So I guess my question is the degree of urgency with which I should try to push this forward. Is this more like “relax, it’s not great, but pretty unlikely anything will happen” or is it more like “your hair should be on fire and you should be out moving things as quickly as humanly possible and buying an AED tonight at the local AED store”
Any informed opinions would be deeply appreciated. Thank you in advance.