I'm not overly familiar with the different drugs/classes that could be involved, but I can sure recognize their effects here!
Definitely a prolonged QT. I'd be keeping an eye open for long-short cycles and T-wave alternans as predictors of imminent lethal arrhythmias, although they certainly aren't required to precede Torsades.
I'm starting to wonder just how many OD-related cardiac arrests, once attributed to respiratory depression/arrest, were actually triggered by lethal arrhythmias 2/2 QT-prolongation. On facebook a few months ago someone shared a nice case of a patient who arrested following narcotic OD, and his post-arrest ECG actually showed a similar markedly prolonged QT. I'm sure everyone blamed hypoventilation for his arrest, but maybe that wasn't the real issue... Unfortunately I lost the link and any chance of getting more info since anything folks post there is buried forever within a week.
I'm not overly familiar with the different drugs/classes that could be involved, but I can sure recognize their effects here!
ReplyDeleteDefinitely a prolonged QT. I'd be keeping an eye open for long-short cycles and T-wave alternans as predictors of imminent lethal arrhythmias, although they certainly aren't required to precede Torsades.
I'm starting to wonder just how many OD-related cardiac arrests, once attributed to respiratory depression/arrest, were actually triggered by lethal arrhythmias 2/2 QT-prolongation. On facebook a few months ago someone shared a nice case of a patient who arrested following narcotic OD, and his post-arrest ECG actually showed a similar markedly prolonged QT. I'm sure everyone blamed hypoventilation for his arrest, but maybe that wasn't the real issue... Unfortunately I lost the link and any chance of getting more info since anything folks post there is buried forever within a week.
I was following up on some blog/facebook comments that I've left over the past few months and happened across the case I mentioned above.
ReplyDeleteHere's the links:
https://www.facebook.com/photo.php?fbid=446361808763335
https://www.facebook.com/ems12lead/posts/484158571619436