Overdrive pacing in a patient with incessant torsades de pointes

A 75-year-old man presented to the emergency department (ED) for syncope and was found to have intermittent runs of torsades de pointes (TdP). The patient had a medical history significant for disseminated coccidiomycosis and was on prophylactic fluconazole. Forty-eight hours prior to presentation,...

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Bibliographic Details
Published inBMJ case reports Vol. 2013; p. bcr2013200146
Main Authors Overbey, Adam N, Austin, Andrea, Seidensticker, Daniel F, Lin, Andrew H
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 11.10.2013
BMJ Publishing Group
SeriesCase Report
Subjects
Aged
Black
Cardiac arrhythmia
Cardiac Pacing, Artificial - methods
Consciousness
Ejection fraction
Electrocardiography
Electrolytes
Etiology
Fainting
Humans
Hypertension
Hypokalemia
Ischemia
Male
Pacemakers
Potassium
Reminder of Important Clinical Lesson
Sinuses
Suffocation
Torsades de Pointes - physiopathology
Torsades de Pointes - therapy
USA/Canada
Vomiting
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Summary:A 75-year-old man presented to the emergency department (ED) for syncope and was found to have intermittent runs of torsades de pointes (TdP). The patient had a medical history significant for disseminated coccidiomycosis and was on prophylactic fluconazole. Forty-eight hours prior to presentation, the patient had intractable nausea and vomiting and was unable to take anything orally. He eventually presented to the ED with severe hypokalaemia and hypomagnesaemia with repeat symptomatic runs of TdP, which required overdrive transvenous pacing. During the patient’'s admission, his electrolytes were aggressively replete. Fluconazole was discontinued, and prior to discharge, the patient recovered fully with ECGs showing a normalisation of the QT interval.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
ObjectType-Feature-4
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ObjectType-Report-1
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ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2013-200146