Long QT Syndrome may cause unexplained ExD deaths

 Published on June 21, 2012 The headlines are often filled with this scenario: a person displaying violent, bizarre and agitated behavior is subdued by law enforcement personnel and later dies in custody. It appears to be a case of police brutality - but is it? According to William P. Bozeman, M.D., an emergency medicine physician at Wake Forest Baptist Medical Center, some of these deaths may be caused by an abnormal cardiac condition called Long QT Syndrome, compounded by a situation of Excited Delirium (ExD) Syndrome. "Why do people become confused, agitated and violent, and then suddenly drop dead? That's the big question," Bozeman said. "This has been seen for well over a century, but we don't have a clear answer. It may be an important link to investigate with future research." Bozeman is lead author of a single case study published online last month ahead of print in the Journal of Emergency Medicine that details an individual who experienced ExD. The 30-year-old man displayed bizarre, agitated behavior and was brought to the Wake Forest Baptist emergency department by police. The patient admitted "feeling funny" and reported recent drug use that a drug screen confirmed. The attending physician recognized an electrical abnormality on the patient's electrocardiogram and diagnosed it as Long QT Syndrome which is potentially life threatening. Bozeman said this was a classic case of ExD, and the patient recovered because of a police sergeant's decision on the scene. "Thanks to the Winston-Salem police sergeant who had been trained to recognize Excited Delirium as a medical crisis, we had a good outcome," Bozeman said. "He made the decision to bring the patient to the emergency department rather than take him to jail. I think the police officer saved his life by making that decision." Long QT Syndrome can be transient or temporary and can be brought on by agitated states such as ExD, Bozeman said. "The amount of adrenaline in the body can affect Long QT Syndrome. In some people, electrical abnormalities are there all the time, while in others they are transient," he said.