Heroin Withdrawal: QT Prolongation & Torsade de Pointes
This is the case of a 61 year old male who presented to the emergency department with a chief complaint of nausea and vomiting. The patient was alert and oriented, reporting intermittent chest pressure for the last 12 hours that he rated as a 9/10 pain level. He also reported multiple syncopal episodes within the last 24 hrs.
Previous Medical History:
Hypertension
Previous MI
Coronary artery disease
2 coronary stents
No known allergies
Medications:
Lisinopril
Plavix
Pravachol
Depakote
Methadone
Initial Vital Signs:
Heart Rate: 72 beats/min
Respiratory Rate: 22 breaths/min
Non-invasive Blood Pressure: 142/78 mmHg
SpO2: 97% on room air
The following 12 Lead ECG is obtained:
Are there any concerns for a potential arrhythmia?
Yes!!! There is a markedly prolonged QT of approximately 644ms (V3 measurement).
The extent of the QT prolongation and the precordial symmetric T wave inversions suggest perhaps a cardiomyopathy may be present.
The QT Interval (QTI) represents the period from the beginning of ventricular depolarization and the end of ventricular repolarization, and although opinions may vary among clinicians, a normal QT length is often considered to be roughly <440 ms (.44s). Ventricular depolarization and repolarization are affected by the heart rate, meaning:
The faster the heart rate, the shorter the QT Interval will be
The slower the heart rate, the longer the QT Interval will be
Because of this, a calculation c...
Source: EMS 12-Lead - Category: Cardiology Authors: Ivan Rios Tags: 12 lead ecg Torsade de Pointes Source Type: research
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