Artigou J Y, Lemonnier M P, Devys J, Clavel J P, Komajda M, Sibra M, Bronstein J A, Grosgogeat Y
Arch Mal Coeur Vaiss. 1986 Jun;79(7):1094-8.
A 72 year old woman was admitted with decompensation of a hypertensive cardiopathy and treated with diuretics. She developed recurrent syncopal torsades de pointes during the 24th hour which were reduced by a bolus intravenous injection of 3 g of magnesium sulphate (Mg SO4). There was a recurrence 30 minutes later which regressed after a second injection of 3 g of Mg SO4. A continuous intravenous infusion of 18 g/day of Mg SO4 prevented further recurrences of the arrhythmia. Biochemical analysis showed intra and extracellular magnesium deficiency at the time of the torsades de pointes but the intracellular potassium was normal. The QT interval was prolonged but this parameter did not change after the bolus of Mg SO4. It returned to normal progressively afterwards. The clinical course was uncomplicated with no recurrences. Metabolic correction was obtained in 3 days. This observation raises the question of the mechanisms relating diuretic therapy, magnesium and torsades de pointes.
一名72岁女性因高血压性心脏病失代偿入院，接受利尿剂治疗。在第24小时内，她出现反复发作的晕厥性尖端扭转型室速，静脉推注3克硫酸镁（Mg SO4）后症状减轻。30分钟后复发，再次注射3克Mg SO4后症状缓解。持续静脉输注18克/天的Mg SO4可防止心律失常进一步复发。生化分析显示，在尖端扭转型室速发作时存在细胞内和细胞外镁缺乏，但细胞内钾正常。QT间期延长，但在推注Mg SO4后该参数未改变。之后逐渐恢复正常。临床过程无并发症，未再复发。3天内实现了代谢纠正。该病例引发了关于利尿剂治疗、镁与尖端扭转型室速之间关系机制的问题。
