Clinical Practice and Cases in Emergency Medicine (Feb 2021)

Unmasking Long QT Syndrome in the Emergency Department: A Case Report

  • Eric Leslie,
  • Andrew Medenbach,
  • Eric Pittman

DOI
https://doi.org/10.5811/cpcem.2020.10.48716
Journal volume & issue
Vol. 5, no. 1

Abstract

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Introduction: Long QT syndrome (LQTS) is an uncommon disorder that can lead to potentially life-threatening dysrhythmias. LQTS can be genetic, acquired, or both. Case Report: A 44-year-old female with well-controlled hypertension and asthma presented with chest tightness. An initial electrocardiogram yielded a normal corrected QT interval of 423 milliseconds (ms) (normal <480 ms in females). Albuterol was administered and induced agitation, tremulousness, and tachycardia. Follow-up electrocardiograms demonstrated extreme prolongation of the corrected QT interval to 633 ms and morphology change of the T wave. Lab values were later notable for hypokalemia and hypomagnesemia, attributable to a recently started thiazide diuretic. The patient was ultimately diagnosed with congenital LQTS after initial unmasking by albuterol in the emergency department. Conclusion: LQTS can be unmasked or exacerbated by electrolyte abnormalities and QT prolonging medications.