What is the clinical evidence from this study?

Study design: Case Report. Population: Cardiac arrest, Torsades de Pointes, prolonged QT (n=1). Intervention: Chronic methadone use and hypokalemia. Primary outcome: Torsades de pointes and prolonged QTc.

What question did this study set out to answer?

To describe a case of cardiac arrest and recurrent torsades de pointes resulting from an interplay between chronic methadone use, hypokalemia, and suspected congenital long QT syndrome.

January 1, 2024Journal of Investigative Medicine High Impact Case ReportsOpen Access

The Perfect Storm: Abnormal Baseline QT With Chronic Methadone Use and Serious Hypokalemia

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Key result

A middle-aged woman with chronic methadone use and hypokalemia experienced cardiac arrest and recurrent Torsades de Pointes, with persistently prolonged QTc despite methadone discontinuation.

Design

Case report

Authors

OLOscar J. LopezThe University of Texas Rio Grande Valley DODiana OthonThe University of Texas Rio Grande Valley YNYilen K. Ng-WongThe University of Texas Rio Grande Valley

Discussion

Member takes

Implication

Clinicians should monitor QTc in long-term methadone users; this case extends reports of isoproterenol responsiveness but leaves optimal management open.

Key Points

To describe a case of cardiac arrest and recurrent torsades de pointes resulting from an interplay between chronic methadone use, hypokalemia, and suspected congenital long QT syndrome.
Clinical evaluation and emergency stabilization of a middle-aged woman with chronic methadone use presenting after out-of-hospital cardiac arrest.
Inpatient management including potassium repletion, isoproterenol infusion, methadone discontinuation, and prescription of nadolol alongside a wearable cardioverter-defibrillator.
Recurrent episodes of torsades de pointes resolved acutely following intravenous isoproterenol administration and aggressive potassium correction.
Prolonged QTc persisted despite the discontinuation of methadone, prompting an outpatient referral for genetic testing to confirm suspected congenital long QT syndrome.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A middle-aged woman with chronic methadone use and hypokalemia who presented with cardiac arrest and multiple episodes of Torsades de Pointes.

Exposure

Isoproterenol, potassium correction, methadone discontinuation, nadolol, and LifeVest

Outcome

Resolution of torsades de pointes and QTc interval monitoring

This case highlights the risk of torsades de pointes in patients with chronic methadone use and hypokalemia, and the importance of evaluating for underlying congenital long QT syndrome if QTc prolongation persists after drug discontinuation.

Cite This Study

Lopez et al. (2024) conducted a case report in Cardiac arrest, Torsades de Pointes, prolonged QT (n=1). Chronic methadone use and hypokalemia was evaluated on Torsades de pointes and prolonged QTc. A middle-aged woman with chronic methadone use and hypokalemia experienced cardiac arrest and recurrent Torsades de Pointes, with persistently prolonged QTc despite methadone discontinuation.

synapsesocial.com/papers/6a89b5216fc170cbc2fbba26 https://doi.org/10.1177/23247096241286373

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Implication

Clinicians should monitor QTc in long-term methadone users; this case extends reports of isoproterenol responsiveness but leaves optimal management open.