QTc Prolongation in Stress-Induced Cardiomyopathy

Figures

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  Figure 1. Telemetry Strips Demonstrating Runs of Ventricular Tachycardia Telemetry recordings showing multiple runs of polymorphic ventricular tachycardia in the setting of marked QTc prolongation. These runs of polymorphic ventricular tachycardia occurred during the patient's initial pulseless cardiac arrest.

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  Figure 2. Baseline 12-Lead Electrocardiogram Showing Prolonged QTc Twelve-lead electrocardiogram demonstrating a prolonged QTc interval (587 ms) in the setting of stress-induced cardiomyopathy. This finding preceded the patient's first episode of polymorphic ventricular tachycardia.

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  Figure 3. Echocardiography Demonstrating Regional Wall Abnormalities Echocardiography images with ultrasound enhancing agent showing regional wall abnormalities in the septal, anterior, and apical segments during systole and diastole. (A) Parasternal long-axis view of end systole. (B) Parasternal long-axis view of end diastole. (C) Parasternal short-axis view of base during end systole. (D) Parasternal short-axis view of mid during end systole. (E) Parasternal short-axis view of apex during end systole. (F) Parasternal short-axis view of base during end diastole. (G) Parasternal short-axis view of mid during end diastole. (H) Parasternal short-axis view of apex during end diastole.

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  Figure 4. Repeat 12-Lead Electrocardiogram Showing Worsening QTc Prolongation Repeat electrocardiogram later the same day showing further QTc prolongation to 680 ms. The marked repolarization abnormality was associated with recurrent ventricular arrhythmias.

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  Figure 5. Repeat 12-Lead Electrocardiogram Showing Reduced QTc After Increased Pacing Repeat electrocardiogram following pacemaker rate increase to 100 beats/min, demonstrating QTc shortening to 508 ms. The intervention successfully reduced the arrhythmogenic substrate and prevented further cardiac arrest.

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  Figure 6. Coronary Angiography Demonstrating Nonobstructive Coronary Arteries Coronary angiogram showing no evidence of obstructive coronary artery disease. The absence of significant stenosis supported the diagnosis of stress-induced cardiomyopathy rather than acute coronary syndrome. (A) Right anterior oblique cranial view of the left coronary system. (B) Left anterior oblique caudal view of the left coronary system. (C) Left anterior oblique cranial view of the right coronary artery. (D) Right anterior oblique cranial view of the right coronary artery.