Arsenic intoxication can cause severe ventricular arrhythmias including torsade de pointes, preceded by QT-U prolongation and T-U wave alternans.
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May prompt arsenic screening in unexplained torsade; case reports leave open incidence and management.
Arsenic intoxication is a common form of heavy metal poisoning. Although arsenic-induced circulatory collapse, seizures, and syncope are well known, the potential for serious ventricular arrhythmias is less well recognized. Reported in this study are two cases of arsenic poisoning causing torsade de pointes. Furthermore, marked prolongation of the QT-U interval and the rarely observed phenomenon of T-U wave alternans are demonstrated. Thus, arsenic intoxication may be complicated by prolongation of the QT-U interval and torsade de pointes. T-U wave alternans occurs in the presence of a long QT-U interval and may be an electrocardiographic warning sign of torsade de pointes.
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LITTLE et al. (1990) studied this question.
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