084 – Prolonged QT syndrome and Torsade de pointes with Graeme.

You are called to review a 35yr old woman at 36 weeks in labour ward who has had a couple of “funny turns” in the last 15 minutes where she became unresponsive and then seemed confused for a few minutes after.

When you get there they tell you she is being induced with cervidil for premature rupture of membranes but she is not in active labour. Because of the PROM she has been started on erythromycin. She has also been unwell with hyperemesis most of the pregnancy but has been vomiting a lot over the last 2 days and has received a lot of medications to try and get on top of it including, ondansetron, droperidol, famotidine and maxalon – with only limited effect. She looks pretty thin and she says she has had a lot of trouble with her weight / nutrition because of her chronic nausea.

The team have done some observations on her – she has a heart rate of 57/min, BP 100/55, she is afebrile and not tachypneic. At this stage the team thinks maybe she is fainting because she is a bit dehydrated but decide to send off some bloods and to do an ECG “to make sure there is nothing else going on”.

Her bloods come back and her potassium is only 2.2 and she is anaemic Hb 95.

The ECG shows the following – what’s wrong?

(Image borrowed from LITFL – Hypokalaemia ECG changes • LITFL • ECG Library)

Suddenly she passes out again whilst the ECG is attached, what are you going to do?

ECG hypokalaemia torsades 2
Image borrowed from LITFL – Polymorphic VT and Torsades de Pointes (TdP) • LITFL

Join Graeme and I as we discuss another fascinating topic after having a couple of patients recently with this challenging but fascinating syndrome…..

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