title: Cardiac arrest and electrical storm due to recurrent torsades de pointes caused by concomitant clarithromycin, cotrimoxazole and amiodarone treatment.
abstract: Torsades de pointes (TdP) is a rapid, polymorphic and usually self-terminating ventricular tachycardia associated with the long QT syndrome. Many drugs may cause prolongation of QT interval and be the trigger for TdP occurrence. We present the case of 52-year-old male who was treated with clarithromycin due to bilateral atypical pneumonia. However, on the fourth day of hospitalization he deteriorated, developed pulmonary edema and short cardiac arrest. After successful resuscitation, unfortunately amiodarone and co-trimoxazole were given causing the arrhythmic storm which required many defibrillations. The case highlights the importance of careful QT measurement, appropriate TdP treatment and difficulties resulting from the patient's disagreement for invasive treatment. We think, that knowledge of drug-induced long QT syndrome and its consequences should be widely spread not only in cardiologists, but also in others doctors.
authors.forename: Piotr
authors.initials: P
authors.lastname: Bienias
authors.forename: Michał
authors.initials: M
authors.lastname: Ciurzyński
authors.forename: Marzanna
authors.initials: M
authors.lastname: Paczyńska
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
mesh_terms: D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D017291:Clarithromycin / Q000008:administration & dosage / Q000009:adverse effects*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004562:Electrocardiography; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000150:complications; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy; D011654:Pulmonary Edema / Q000209:etiology; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000150:complications*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000889:Anti-Arrhythmia Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017291:Clarithromycin; D000638:Amiodarone