Multi-Factorial Causes of Torsade de Pointes in a Hospitalised Surgical Patient = الأسباب المتعددة لإلتواء تخطيط القلب حول النقطة في مريض جراحي داخل المستشف

Abstract

abstract:A 55-year-old chronic alcoholic male known to be positive for human immunodeficiency virus (HIV) was admitted to a surgical ward following perianal abscess drainage. He was noted to have sinus bradycardia, ventricular premature complexes, and mild hypotension. His laboratory investigations revealed mild hypokalaemia. He was intermittently agitated and alcohol withdrawal syndrome (AWS) was diagnosed. Postoperatively, he received intravenous piperacillin/tazobactam and metronidazole infusions along with a small dose of dopamine. Analysis of a 24-hour Holter monitor (ECG) showed a prolonged QT interval with two episodes of self-terminating torsade de pointes. His AWS was treated, hypokalaemia was corrected, and dopamine, along with antibiotics, was withdrawn. There was no recurrence of arrhythmias. This case highlights the importance of avoiding QT-prolonging drugs in hospitalised patients, since hospitalised patients often have multiple risk factors for a proarrhythmic response. Keywords Case ReportA 55-year-old non-diabetic, non-hypertensive male was admitted to the surgical ward at the Royal Hospital, Muscat, Oman, following perianal abscess drainage surgery. He was referred to a cardiologist for sinus bradycardia, ventricular premature complexes (VPCs), and mild hypotension, which were not present pre-operatively. He was not on any regular medications but was receiving regular doses of piperacillin/tazobactam and metronidazole infusions as antibiotics along with a dopamine infusion of 5 μg/kg/minute postoperatively. No cardiovascular symptoms were described. His past medical history had included chronic alcoholism and human immunodeficiency virus (HIV) positivity but he was without any history of substance abuse. An examination