Russell Leslie, Levine Daniel
Internal Medicine Resident at Warren Alpert School of Medicine (Rhode Island Hospital).
R I Med J (2013). 2013 Jul 30;96(8):20-1.
Torsades de pointes is a polymorphic ventricular tachycardia that can quickly evolve into ventricular fibrillation and sudden death. This arrhythmia often occurs secondary to medication- induced cardiac repolarization dysfunction with resultant prolonged QTc interval on ECG. Numerous medications can predispose patients to this deadly tachycardia. We report a case of methadone-induced Torsades de pointes complicated by ventricular fibrillation and cardiac arrest. Through rapid taper of methadone, the patient's ECG normalized, allowing for safe discharge. This clinical vignette highlights the importance of close monitoring of patient medications. Performing periodic ECGs with prompt removal of offending agent when repolarization abnormalities are appreciated is ideal. Most importantly, as the vast array of medications continues to grow, it is imperative that clinicians are cognizant of side effects and tailor treatment accordingly.
尖端扭转型室速是一种多形性室性心动过速，可迅速演变为心室颤动和猝死。这种心律失常常继发于药物诱导的心脏复极功能障碍，导致心电图上QTc间期延长。许多药物可使患者易患这种致命的心动过速。我们报告一例美沙酮诱发的尖端扭转型室速，并发心室颤动和心脏骤停。通过迅速减少美沙酮用量，患者的心电图恢复正常，得以安全出院。这个临床案例突出了密切监测患者用药的重要性。当发现复极异常时，定期进行心电图检查并及时停用致病药物是理想的做法。最重要的是，随着药物种类的不断增加，临床医生必须认识到药物副作用并相应调整治疗方案。
