Ott William P, Bellamy Shannay E, Khan Muzzamil, Shahid Ahmad, Javed Mohammad T
Internal Medicine, Jersey City Medical Center, Jersey City, USA.
Cardiology, Jersey City Medical Center, Jersey City, USA.
Cureus. 2023 Apr 7;15(4):e37263. doi: 10.7759/cureus.37263. eCollection 2023 Apr.
Long QT syndrome (LQTS) occurs when there is an abnormality of myocardial repolarization characterized specifically by a prolonged QT interval on an electrocardiogram (ECG). This can be particularly dangerous as it is associated with an increased risk of polymorphic ventricular tachycardia and a life-threatening arrhythmia otherwise known as torsades de pointes (TdP). We present a case of a 40-year-old Indian female whose medical history was significant only for anemia and depression/anxiety that presented in a ventricular fibrillation cardiac arrest after becoming dyspneic and light-headed while dancing. Of relevance, she was taking sertraline 50mg once daily, a class of medications known to prolong the QT interval as well as having low serum calcium on presentation. Both her initial and subsequent electrocardiograms illuminated significantly prolonged QTc intervals. She subsequently sustained a ventricular tachycardia cardiac arrest, which degenerated into ventricular fibrillation in the cardiac intensive care unit two days later. Ultimately, the patient was pronounced brain-dead by the end of the week. We concluded this to be a case of LQTS predisposing to TdP, which then would degenerate into ventricular fibrillation. This case highlights multiple risk factors that are known to predispose to the aforementioned etiology. Further research is needed not only on common medications and their dose-dependent relationship on the QT interval across different ethnic groups but also on educating providers regarding multiple risk factors they may or may not have the power to control.
长QT综合征(LQTS)是指心肌复极异常,其特征为心电图(ECG)上QT间期延长。这可能特别危险,因为它与多形性室性心动过速风险增加以及一种危及生命的心律失常(即尖端扭转型室速,TdP)有关。我们报告一例40岁印度女性病例,其病史仅显著存在贫血以及抑郁/焦虑,该患者在跳舞时出现呼吸困难和头晕后,发生心室颤动心脏骤停。相关的是,她每天服用一次50mg舍曲林,这类药物已知会延长QT间期,且就诊时血清钙水平低。她最初及后续的心电图均显示QTc间期显著延长。两天后,她在心脏重症监护病房发生室性心动过速心脏骤停,并恶化为心室颤动。最终,该患者在周末被宣布脑死亡。我们认定这是一例易发生TdP的LQTS病例,随后TdP会恶化为心室颤动。该病例突出了已知易导致上述病因的多种危险因素。不仅需要进一步研究常用药物及其在不同种族群体中对QT间期的剂量依赖性关系,还需要对医疗服务提供者进行教育,使其了解他们可能有或可能无法控制的多种危险因素。