Abstract
An 81-year-old lady was admitted to our hospital with a 3-year history of noninfective diarrhoea and recurrent syncopal events over the last 3 months. Her initial electrocardiogram (ECG) revealed trigeminy and prolonged QTc interval. She had a structurally normal heart with no coronary artery disease. Investigations revealed low potassium at 3.0 mmol/L. Sigmoidoscopy and colonoscopy suggested a possible diagnosis of diverticulitis. Soon after admission she had an unresponsive episode with spontaneous recovery. Telemetry and Holter analysis confirmed multiple episodes of polymorphic ventricular tachycardia (Torsade de Pointes). Following electrolyte supplementation the episodes of polymorphic VT improved. Due to the protracted nature of the diarrhoea, the recurrent syncopal events, and recurrent hypokalaemia documented over recent years, an Implantable Cardioverter Defibrillator (ICD) was sanctioned by the multidisciplinary team (MDT). In summary, chronic diarrhoea may result in life threatening polymorphic VT due to hypokalaemia and QTc prolongation. In these patients an ICD may be considered.
Highlights
Electrolyte abnormalities are common in patients with prolonged diarrhoea
We report the case of a lady, the first we are aware of, who suffered from hypokalaemia and a history of recurrent syncopal events related to Torsades de Pointes as a result of persistent and intractable diarrhoea
Polymorphic VT (Torsade de Pointes) is a distinctive form of ventricular tachycardia characterised by oscillation of the QRS complex around the isoelectric axis and it predisposes to sudden cardiac death
Summary
Electrolyte abnormalities are common in patients with prolonged diarrhoea. We report the case of a lady, the first we are aware of, who suffered from hypokalaemia and a history of recurrent syncopal events related to Torsades de Pointes as a result of persistent and intractable diarrhoea.
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