Case 10: Torsade de pointes
A 51-year-old female was admitted with cardiopulmonary arrest (following
chest pain). ECG showed torsade de pointes (Tdp). The patient was
successfully revived after 20 minutes of resuscitation (cardio-version
and lidocaine administration). Serum electrolytes were normal. Also, she
was not receiving QT-prolonging agents. Moreover, the chest CT scan
showed bilateral GGO (Figure 1J). TTE showed LVEF of 35%, normal LV
size, increased LV wall thickness (13mm), no pericardial effusion, no
valvular lesion, and no LV clot. The patient received IVIG (1 gram),
broad-spectrum antibiotics (meropenem and doxycycline), high-dose
corticosteroid (1 mg/kg methylprednisolone/day), and remdesivir for
COVID-19. Hemodynamic condition improved after twelve hours. Angiography
revealed a non-significant (<50%) lesion in the mid-part of
the left anterior descending artery (Figure 5). TTE (after ten days)
revealed an improved LVEF of 50% with mildly increased LV wall
thickness (11mm). Also, the cTnI was reduced. The patient was discharged
in ten days in good condition.