case_images: PMC7532395_01
case_images: (a) 12-lead ECG revealed sinus rhythm with frequent PVCs. (b) Telemetry showed polymorphic premature ventricular contractions and R on T, and TdP was initiated. (c) QRS amplitude varied, and QRS complexes appeared to twist around the baseline, suggestive of TdP. (d) Self-termination of TdP.
case_images: CRIC2020-4504657.001.jpg
case_images: PMC7532395_01_CRIC2020-4504657.001.jpg
case_images: fig1
case_images: On arrival, physical examination showed body weight: 55 kg, body temperature: 36.5 C, blood pressure: 114/70 mmHg, and pulse: 124/min. 12-lead electrocardiography (ECG) revealed sinus rhythm with frequent premature ventricular contractions (PVCs) (Figure 1(a)). ECG monitor showed polymorphic PVCs, R on T, and QT prolongation, suggestive of torsade de pointes (TdP) with unstable hemodynamic status (Figures 1(b) and 1(c)). After three times of 200 J biphasic cardioversion defibrillation, ECG rhythm was converted to sinus rhythm spontaneously by herself (Figure 1(d)).
case_images: (a) After termination of TdP, repeated ECG revealed sinus rhythm with significant QT prolongation and QT interval was about 600 milliseconds. (b) ECG showed sinus rhythm with bigeminy PVC and R on T.
case_images: CRIC2020-4504657.002.jpg
case_images: PMC7532395_01_CRIC2020-4504657.002.jpg
case_images: fig2
case_images: Repeated ECG showed sinus rhythm with obvious QT prolongation (QT interval > 600 milliseconds) (Figure 2(a)) and intermittent bigeminy PVC with R on T (Figure 2(b)).
case_images: (a) The ECG without methadone use showed normal QT interval. (b) After discontinuation of methadone use, QT interval was shortened to near 460 milliseconds.
case_images: CRIC2020-4504657.003.jpg
case_images: PMC7532395_01_CRIC2020-4504657.003.jpg
case_images: fig3
case_images: Moreover, the previous ECG without methadone use was documented about 2 years ago (Figure 3(a)). QT interval was shortened to near 460 milliseconds within 2 weeks (Figure 3(b)).