From Misdiagnosis to Recognition: Torsades de Pointes Masquerading as Non-sustained Ventricular Tachycardia

Figure 1. Initial ECG at the outside hospital emergency department, showing a polymorphic ventricular tachycardia with wide QRS complexes (torsades de pointes appearance). The red box highlights torsades de pointes, a polymorphic ventricular tachycardia, which was misinterpreted as a non-sustained ventricular tachycardia.

Figure 2. Telemetry strip showing torsades de pointes, a polymorphic VT with oscillating QRS amplitude, creating the classic “twisting of the points” morphology. The red box highlights torsades de pointes, a polymorphic ventricular tachycardia.

Figure 3. ECG on the day of discharge, demonstrating sinus bradycardia with a prolonged QTc of 481 ms (dark gray bar indicates the measured QT interval from the start of the Q wave to the end of the T wave; light gray bar indicates the upper limit of normal QT interval of 460 ms for females). The arrow corresponds to the prolonged QT interval, which was measured before discharge.

Figure 4. The most recent follow-up ECG demonstrates a prolonged QT interval (>480 ms), as marked by the black solid bar, suggestive of persistent QT prolongation. The arrow corresponds to a prolonged QT interval on the most recent clinic follow-up visit.