Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management

A young woman presented with intermittent shocks from her implantable defibrillator.  She was intermittently unconscious and unable to give history.   The monitor showed intermittent polymorphic ventricular tachycardia.    The physician was presented with this ECG at the same moment he was observing the repeated syncope:Time zeroIt is a bigeminal rhythm with a very bizarre PVC.  The PVC has an incredibly long QT, but the intervening native rhythms do not.  However, when I saw this (it was texted to me), it immediately reminded me of this case, so I knew by sheer recognition that it was long QT and the patient was having Torsades de Pointes.  The patient was moved to the critical care area.  An ICD was noted on her chest.  Vital signs were normal when the rhythm was normal. Another ECG was recorded 8 minutes later:The computer measures the QT as 435 ms and QTc as 435 ms.  What do you think? As I have pointed out many times, the computer is awful at making the diagnosis of long QT.See these posts:Do not trust the computerized QT when the QT is longAltered Mental Status, possible ingestion.  What does the ECG show?The QT is at least 640 ms, and QTc(Bazett) also = 640 ms (RR interval = 1)The monitor showed continued bursts of tachycardia, and another 12-lead was recorded, this one at 15 minutes:Polymorphic VT initiated by R on TAt 22 minutes, 4 continuous ECGs were recorded:More R on T initiating TorsadeSame. N...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs