engleski

Concomitant risk factors for acquired QT prolongation and torsades de pointes: a case report

ntroduction: Acquired QT prolongation can be caused by drug therapy and electrolyte abnormalities but can also occur as a result of raised intracranial pressure (ICP). QT prolongation is associated with torsades de pointes (TdP), a life-threatening form of polymorphic ventricular tachy-cardia. Case report: 36-year-old man with a known opioid addic-tion and receiving methadone maintenance therapy (100 mg/day), came to emergency room after an epileptic sei-zure. On the admission day he took additional unknown dose of methadone. An expansive intracranial process with cerebral edema was found on CT scan. The ECG showed sinus bradycardia and prolonged QT interval, he had recurrent episodes of TdP, some requiring defibril- lation (Figure 1 and Figure 2). Intravenous magnesium was immediately applied. Serum potassium and calcium were mildly decreased and therefore adequately correct-ed. Antiedematous therapy with glucocorticoids was also initiated. Methadone could not be discontinued because of abstinence syndrome, but the dose was reduced. Acute coronary syndrome was excluded, and no structural heart disease was found.

methadone, intracranial pressure, torsades de pointes.

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