Scenario: This is a bedside ECG alarm printout for “VFIB/VTAC” in a 44-year-old woman admitted to the intensive care unit 3 days earlier. At the time of the alarm, the patient was sitting up in a chair, which she had been tolerating well. Upon entering the room, the nurse found the patient awake but shaking and pale. She was lifted back to bed, after which time the rhythm was normal sinus. The patient was admitted after having been found unconscious at the bottom of a ravine for an unknown period. She has a history of bipolar disorder and substance abuse, with a toxicology screen positive for amphetamines and benzodiazepines. Current medications include an antidepressant and an anticonvulsant. She is receiving hemodialysis. The routine morning 12-lead ECG showed normal sinus rhythm with lengthened QTc interval.
Sinus tachycardia (97/min), right bundle branch block, and artifact mimicking torsades de pointes
Torsades de pointes...
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