PMC7511244_01
Representative electrocardiograms of the patient on admission and prior to episodes of torsade de pointes. a Admission electrocardiogram of the patient demonstrating normal sinus rhythm; QTc: 441 ms. b Electrocardiogram of the patient 2 days prior to developing torsade de pointes demonstrating normal sinus rhythm and nonspecific T wave abnormality in anterior leads. QTc: 467 ms
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Fig1
Baseline electrocardiograms (ECG) on admission and during the initial hospital course were noted as normal sinus rhythm with a normal QT/QTc interval (441 ms, 467 ms) (Fig. 1a, b).
Representative telemetry strips and electrocardiograms of the patient during and after the episode of torsade de pointes. a Representative telemetry strips of the patient demonstrating first episode (top) and second episode of torsade de pointes (TdP) (bottom 4). b Electrocardiogram of the patient right after TdP was terminated demonstrating sinus tachycardia (123 bpm) and nonspecific ST-T wave abnormality QTc: 380 ms. c Electrocardiogram of the patient a few hours after termination of TdP demonstrating normal sinus rhythm (92 bpm) and nonspecific T wave abnormality QTc: 398 ms
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Fig2
Subsequently, she became unresponsive and noted to have two episodes of polymorphic ventricular tachycardia (PVT) (Fig. 2a). She was febrile during the episodes with a temperature of 39.4  C (102.92  F). There were no ECG findings suggestive of ischemia (Fig. 2b, c). Following both arrhythmias (atrial fibrillation and TdP), the patient had converted to sinus tachycardia with QTc interval of 380 ms (normal range < 470 ms) (Fig. 2b) before medications (including intravenous potassium) or cardioversion could be administered. ECG after electrolyte administration demonstrated normal sinus rhythm with QTc interval of 398 ms (Fig. 2c).