A rare complication of an extraadrenal pheochromocytoma. It is usually drug related and may be either selflimiting or progressing to ventricular fibrillation. We present the case of a child with neurological impairment. It is characterized by rapid, irregular qrs complexes, which appear to be twisting around the electrocardiogram ecg baseline. Qt is difficult to see because of artefact but appears slightly prolonged qtc 480ms, making this likely to be tdp. Common causes of qt prolongation are usually considered in the clinical setting, such as electrolyte imbalances, medication side effects, congenital syndromes. In patients with severely injury of the cns it is a latent risk. Read the chapter on the long qt syndrome for an list of causes. The ventricles are the two lower chambers of the heart that.
Poly just implies that there are multiple, that there are multiple qrs intervals. Imipenemcilastatin and piperacillintazobactam are two antibiotics with broad antimicrobial coverage. Previous cardiac investigations had been normal and after a second episode of ventricular fibrillation the patient was referred for electrophysiological studies. A 69yearold man with past medical history of coronary artery disease, status postcoronary artery bypass, ischaemic cardiomyopathy with ejection fraction of 15%, status postautomatic implantable cardioverter defibrillator since 20, known case of ventricular tachycardia vt, on sotalol, irritable. Torsade des pointes an overview sciencedirect topics.
Besides the many well established adverse effects of these drugs, there have been few case reports of hypokalemia. Methadone is a synthetic opioid that has been used successfully to treat heroin addiction and chronic pain. Measurement of qt interval should be corrected for heart rate. Sacchi division of cardiology, long island college hospital, brooklyn, ny gowda, wilbur, vasavada, sacchi and division of cardiology, creighton university school of medicine, khan omaha, ne 6812044, usa.
As for children, there are few reports focusing on it. It most often occurs in the presence of a prolonged qt interval on the ecg, a slow heart rate, andor disturbances in blood electrolyte balance. Tdp was induced 2 hr after the drug administration and degenerated into ventricular fibrillation. If so, share your ppt presentation slides online with. This can be an iatrogenic arrhythmia and due to drugs, or may be genetic in origin. This arrhythmia may cease spontaneously or degenerate. It was first described by dessertenne in 1966 and refers to a specific variety of ventricular tachycardia that. Long qt syndrome presenting as epileptic seizures in an adult. This arrhythmia may cease spontaneously or degenerate into ventricular fibrillation.
It was first described by dessertenne in 1966 and refers to a specific variety of ventricular tachycardia that exhibits distinct characteristics on the ecg. Astemizole was orally administered in a dose of 30 mgkg. Fifty or more drugs, both typical antiarrhythmic agents such as quinidine as. Torsades can be caused by either congenital longqt syndrome or acquired longqt syndrome due to electrolyte abnormalities andor medications. In reply we would like to thank dr noheria for his interest in our article. Frequent pvcs with r on t phenomenon trigger a run of polymorphic vt which subsequently begins to degenerate to vf. Qt interval prolongation is commonly observed in acute alcohol withdrawal and cirrhotic cardiomyopathy.
Editor i read with interest, the lesson of the month 1. A 50 year old woman with a previous diagnosis of epilepsy presented to the emergency department with a generalised seizure. Other electrocardiographic manifestations that accompany significant qt prolongation include macro twave alternans twa. The paper to which they refer describes two patients who presented with ventricular fibrillation associated with hypomagnesemia.
It is usually well tolerated and has few side effects. In torsades you have a long qt thats followed by a polymorphic vtach. It is a polymorphic ventricular tachycardia that exhibits distinct characteristics on the electrocardiogram ecg. The blockade of i kr potassium current by these drugs is responsible for their proarrhythmic effect. Survival after prolonged resuscitation with 99 defibrillations due to. The qrs axic oscillated with definite changes in direction. Torsades usually occurs in a pause dependent fashion. First, a change in the amplitude and morphology twisting of the qrs complexes around the isoelectric line is a typical feature of. As recent research has proposed, longterm excessive alcohol. Long qt syndrome presenting as epileptic seizures in an. Torsades definition of torsades by medical dictionary.