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: Tags: 12 lead ecg Torsade de Pointes Source Type: research