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Bigeminy with Prolonged QT Interval as an Ominous Sign for Impending Torsades de Pointes: A Case Report

Thuc Vu1, Jake Valentine2,3

  • 1Kansas City University College of Osteopathic Medicine, Kansas City, Missouri.

Clinical Practice and Cases in Emergency Medicine
|February 4, 2025
PubMed

Insights

Ventricular bigeminy with a prolonged corrected QT interval (QTc) can predict life-threatening torsades de pointes. Prompt recognition and treatment of this ECG finding are crucial for patient survival.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Clinical Medicine

Background:

  • Ventricular ectopic beats and prolonged corrected QT interval (QTc) are common but usually benign.
  • Predicting subsequent dysrhythmias from isolated ECG features is challenging.
  • Combining ventricular bigeminy and QTc prolongation may improve risk stratification for torsades de pointes.

Observation:

  • An 84-year-old female presented with syncope.
  • Electrocardiogram (ECG) revealed bigeminy and a prolonged QTc interval.
  • The patient developed torsades de pointes shortly after the ECG was obtained.

Findings:

  • The case highlights a bizarre bigeminal rhythm with QTc prolongation, likely induced by memantine and hypokalemia.
  • Ventricular bigeminy in the context of QTc prolongation served as a critical warning sign for torsades.
  • The patient experienced multiple cardiac arrests during hospitalization.

Implications:

  • Recognizing ventricular bigeminy alongside QTc prolongation is vital for identifying patients at high risk for torsades.
  • Prompt investigation and management of underlying causes are essential to prevent potentially fatal arrhythmias.
  • This case underscores the importance of comprehensive ECG interpretation in patients with syncope or falls.
Abstract

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