Key result
A 55-year-old woman developed acquired long QT syndrome and polymorphic ventricular tachycardia secondary to an atypical variant of stress-induced cardiomyopathy triggered by anaesthetic induction.
Case Report (n=1)
Atypical stress-induced cardiomyopathy can present with acquired long QT syndrome and polymorphic ventricular tachycardia, and cardiovascular magnetic resonance is valuable for identifying the characteristic patchy myocardial oedema.
Alerts clinicians to anesthesia as rare trigger for atypical stress cardiomyopathy with acquired LQTS/VT; leaves open broader phenotypic spectrum pending additional cases.
A 55-year-old woman with a recent history of surgically and radioiodine treated thyroid cancer experienced a run of polymorphic ventricular tachycardia with hemodynamic perturbation during anaesthetic induction with propofol, fentanyl and rocuronium for elective surgical excision of right hip metastasis. Electrocardiography showed new T-wave inversion and QT prolongation that subsequently resolved. Cardiac enzymes were elevated but invasive coronary angiography showed unobstructed epicardial coronary arteries. Cardiovascular magnetic resonance showed not only normal biventricular size and systolic function but also a striking pattern of patchy myocardial oedema involving the basal-to-mid anterior, septal and inferior walls and some associated hypertrophy in the anteroseptum (representing focal myocardial swelling from the oedema) but no focal or diffuse myocardial fibrosis. All these abnormalities resolved on subsequent convalescent imaging. A diagnosis of multifactorial acquired long QT syndrome secondary to atypical variant stress-induced cardiomyopathy was made with the likely provoking factors in this case having been the female sex, understandable pre-operative anxiety, anaesthetic drugs, supraglottic airway placement and thyroid dysfunction. An implantable loop recorder during follow-up detected no further significant arrhythmias and she remains well and asymptomatic to date on a low dose of beta-blocker.
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Alfarih et al. (2020) conducted a case report in Atypical variant of stress-induced cardiomyopathy, acquired long QT syndrome, polymorphic ventricular tachycardia (n=1). Anaesthetic induction and supraglottic airway placement in the setting of thyroid dysfunction and anxiety was evaluated on Development of polymorphic ventricular tachycardia and acquired long QT syndrome. A 55-year-old woman developed acquired long QT syndrome and polymorphic ventricular tachycardia secondary to an atypical variant of stress-induced cardiomyopathy triggered by anaesthetic induction.
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