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Summary

This summary is machine-generated.

Torsades de pointes (TdP), a dangerous heart rhythm, can be caused by methadone treatment, especially with hepatitis infections. This case highlights the need for vigilant monitoring and management of TdP in at-risk patients.

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Area of Science:

Cardiology
Pharmacology
Infectious Diseases

Background:

Torsades de pointes (TdP) is a polymorphic ventricular tachycardia associated with QT interval prolongation.
Various medications, including methadone, can prolong the QT interval and increase TdP risk.
Co-existing conditions like hepatitis B/C infection can exacerbate drug-induced QT prolongation.

Observation:

A former intravenous heroin user presented with recurrent TdP episodes.
QT prolongation was attributed to methadone treatment, worsened by hepatitis B/C infection.
Despite methadone withdrawal and aggressive treatment, the patient required temporary cardiac pacing for six days.

Findings:

The patient exhibited moderate left ventricular (LV) dysfunction on echocardiogram.
Coronary angiography revealed unobstructed coronary arteries.
Recurrent TdP episodes persisted despite medical management and methadone cessation.

Implications:

This case underscores the significant risk of methadone-induced TdP, particularly in patients with hepatitis infections.
Continuous cardiac pacing and eventual defibrillator implantation were necessary due to persistent arrhythmia risk.
Vigilant monitoring for QT prolongation and TdP is crucial in patients on methadone, especially those with underlying liver conditions.