What are these bizarre bigeminal PVCs??

Case 1This ECG was texted to me last week with the question: " What is this?? "What do you think?My answer:" This is a pre-torsades EKG. Watch out!  Every other beat, a PVC, has anextremely long QT.  In my experience, patients with ECGs like this are at very high risk of TORSADES. I have seen this several times. " OutcomeIt came from a patient who had been falling much, had a K of 2.8, and is on methadone but taking too much.  The patient then received K and Mg.  Torsades did not ensue.  The ECG findings resolved after metabolism of methadone and K replenishment. See several similar cases below, all of which were recorded before, during, or after Torsades de Pointes.Case 2.  Polymorphic Ventricular TachycardiaThis patient was also on Methadone.  She had this 12-lead recorded immediately before the above one:Torsades de PointesCase 3Long QT Syndrome with Continuously Recurrent Polymorphic VT: ManagementCase 3, 8 minutes laterCase 3, laterCase 3, laterCase 3, laterCase 3, laterCase 3, laterCase 4, had Torsades after these ECGsSame patient as " case 4, " a bit laterSee these posts:Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.Polymorphic Ventricular Tachycardia
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs