Epinephrine-Induced Polymorphic Ventricular Tachycardia in a Patient With Congenital Long QT Syndrome.
A 24-year-old woman presented to the department of plastic surgery for surgical excision of a nevus on her nose. Although her history failed to reveal any cardiac disease, her pre-operative electrocardiogram (ECG) showed an extremely prolonged QT interval of up to 528 msec. Repeated history-taking after admission revealed three syncopal episodes associated with both physical and emotional stress, and because the two-dimensional echocardiography and exercise ECG test were normal except for the prolonged QT interval, an epinephrine test was done to assess QT interval changes after an epinephrine infusion. Immediately after a bolus injection of epinephrine (0.1 microg/kg), marked prolongation of the QT interval developed, followed by polymorphic ventricular tachycardia which was immediately terminated with direct current shock, resulting in the diagnosis of a long QT syndrome (LQTS), probably type 1. Gene studies were recommended, but declined by the patient and her family. She was instructed to avoid competitive sports, and a beta-blocker was prescribed after which she remained symptom-free.
Kim
Jae Hee
JH
Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
Park
Sun Hee
SH
Kim
Kyun Hee
KH
Choi
Won Suk
WS
Kang
Jung Kyu
JK
Kim
Na Young
NY
Cho
Yongkeun
Y