Cardiac arrest due to long QT syndrome associated with excessive consumption of energy drinks

Abstract

Amphetamines 1000 Negative Barbiturates 300 Negative Benzodiazepines 300 Negative Cannabinoids 50 Negative Cocaine 300 Negative MDMA 500 Negative Metamphetamine 1000 Negative Methadone 300 Negative The congenital form of long QT syndrome is characterized by a prolonged QT interval in the electrocardiogram (ECG) and is complicated by episodes of polymorphic ventricular tachycardia known as torsades de pointes (TdP). Patients with long QT syndrome 1 (LQTS-1) typically may suffer cardiac arrest during exercise. Based on these observations beta-blocker therapy is recommended in these patients to reduce the maximal heart rate and blunt the effects of adrenaline. Energy drinks contain high doses of taurine (an amino acid), caffeine and glucuronolactone (a glucose metabolite), neither of which is considered to have significant toxicity. We report a case of a 22 year old female with out of hospital cardiac arrest (OHCA) due to initial torsades de pointes tachycardia secondary degenerating to ventricular fibrillation. Sudden cardiac death occurred without prodrome in a discotheque. Basic life support was performed immediately. After 15 minutes of resuscitation with fractionated administration of 3 mg adrenaline return of spontaneous circulation (ROSC) could be achieved after the patient received five 360 Joule shocks by the emergency medical services personnel. Initial ECG showed torsades de pointes tachycardia, which degenerated during resuscitation to ventricular fibrillation. After ROSC the patient was admitted to our intensive care unit. Acute cardiac catheterization excluded coronary macroangiopathy or coronary anomalies. Cardiac ventriculography revealed a normal ejection fraction of 69. Echocardiography showed normal cardiac function without any pathologic pattern. Furthermore, no pericardial effusion was found. Results of a urinary screen for drug or alcohol misuse were negative (Table 1). Potassium level at admission was normal (4.4 mmol/l). Abnormal