PMC7532395_01
(a) 12-lead ECG revealed sinus rhythm with frequent PVCs. (b) Telemetry showed polymorphic premature ventricular contractions and R on T, and TdP was initiated. (c) QRS amplitude varied, and QRS complexes appeared to twist around the baseline, suggestive of TdP. (d) Self-termination of TdP.
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On arrival, physical examination showed body weight: 55 kg, body temperature: 36.5 C, blood pressure: 114/70 mmHg, and pulse: 124/min. 12-lead electrocardiography (ECG) revealed sinus rhythm with frequent premature ventricular contractions (PVCs) (Figure 1(a)). ECG monitor showed polymorphic PVCs, R on T, and QT prolongation, suggestive of torsade de pointes (TdP) with unstable hemodynamic status (Figures 1(b) and 1(c)). After three times of 200 J biphasic cardioversion defibrillation, ECG rhythm was converted to sinus rhythm spontaneously by herself (Figure 1(d)).
(a) After termination of TdP, repeated ECG revealed sinus rhythm with significant QT prolongation and QT interval was about 600 milliseconds. (b) ECG showed sinus rhythm with bigeminy PVC and R on T.
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Repeated ECG showed sinus rhythm with obvious QT prolongation (QT interval > 600 milliseconds) (Figure 2(a)) and intermittent bigeminy PVC with R on T (Figure 2(b)).
(a) The ECG without methadone use showed normal QT interval. (b) After discontinuation of methadone use, QT interval was shortened to near 460 milliseconds.
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Moreover, the previous ECG without methadone use was documented about 2 years ago (Figure 3(a)). QT interval was shortened to near 460 milliseconds within 2 weeks (Figure 3(b)).