Fortunately, a woman among those fleeing the theater knew CPR and immediately started chest compressions. Within two minutes a defibrillator was brought, which restarted Jessica's heart. Miraculously, she suffered no permanent damage. She was told by the cardiologist at the hospital where she was taken that this was likely a one-time event. However, that optimistic diagnosis was contradicted by the second cardiologist she consulted, several weeks later, after she'd obtained the results from the electrocardiogram (EKG) performed at the time of the defibrillation.
The EKG showed that Jessica had suffered a torsade de pointes, a type of ventricular tachycardia which caused her heart's two lower chambers (the ventricles) to beat faster than the two upper chambers (the atria). The doctor concluded that this was a result of a long QT interval, a condition in which the heart muscle takes longer than normal to recharge between beats. He surmised that the long QT interval was likely due to a congenital defect and warned that Jessica could go into cardiac arrest again at any moment.
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| Courtesy of Blausen.com staff (2014) |
A few months have now passed and Jessica is doing fine. The ICD, which is implanted below her left collarbone, makes it uncomfortable for her to sleep on that side, but that's a minor inconvenience compared to the benefit it provides.
In the midst of her adjustment to life after such a major trauma, Jessica made another change — she went off the ketogenic diet, which she had been on for more than a year. When I heard about this, something clicked — I wondered whether the diet had a connection to Jessica's heart problem.
What is the ketogenic diet? Basically, it's a high fat, very low carbohydrate, moderate protein diet. The standard keto diet consists of 75% fat, 5% carbohydrates, and 20% protein. The diet encourages ketosis, a state in which the body, deprived of sufficient amounts of its normal fuel, glucose, burns fat instead — a desirable result for people who want to lose weight. It's also been found to reduce seizures in epileptic children, when followed rigorously. In an article by the Epilepsy Foundation, it's noted that the diet doesn't provide several essential minerals and vitamins, among them selenium, so supplementation is necessary.
Why is this relevant to Jessica's situation? After I postulated that there might be a connection between her heart event and the keto diet, I did a simple Google search for "torsade de pointes and ketogenic diet." One hit was an abstract of a 2008 article in Pediatric Neurology, describing the cases of two epileptic children who had been on the keto diet and died. One was found to have "complications related to torsade de pointes, with documented QT prolongation." The second child "experienced QT prolongation while on the ketogenic diet and later died suddenly at home." I was struck by the fact that both children "exhibited selenium deficiency."
In the abstract, the authors state that "two complications related to the ketogenic diet are selenium deficiency, which has been associated with impaired myocardial function, and QT prolongation as documented on electrocardiography." They don't speculate about causality, however. That is, they don't address whether the QT prolongation might be caused by the selenium deficiency.
However, another abstract found during my Google search suggests a connection. The abstract of a 2012 article in the Journal of Clinical Neuroscience describes the authors' attempt to evaluate the effect of the keto diet on the QT interval by performing electrocardiograms on 27 children with refractory epilepsy after they'd been on the diet for one, three, six, and twelve months. No changes in the QT interval were found, and no heart problems. Interestingly, all the patients had been supplemented with oral calcium and selenium, which makes me wonder whether the selenium supplementation might have prevented QT interval problems from developing.
At the time of her cardiac arrest, Jessica was following the ketogenic diet, but now that she's been off it for a number of months, any selenium deficiency she might have had will probably have been corrected. So, it may be impossible to know for sure whether the diet led to Jessica's near-fatal arrhythmia. If there was a direct connection, though, I wonder whether the QT prolongation will persist now that Jessica has discontinued the diet, or whether it will revert to normal, making a recurrence unlikely.
I am sure of one thing — Jessica should never go on that diet again, even with selenium supplementation. That's one recommendation I can confidently make without a medical license.
Note: Click on image to enlarge it.
