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Torsades de pointes — ACEM Fellowship MCQ

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ModerateCardiovascular emergenciesTorsades de pointesACEM Fellowship

A 41-year-old woman presents to a Perth ED, triage category 1, after recurrent syncope. She recently started erythromycin and takes methadone. Monitor shows polymorphic wide-complex tachycardia with twisting QRS morphology; QTc between episodes is 560 ms. BP is 88/50. What is the most likely diagnosis?

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Correct answer: E — Torsades de pointes

QT prolongation with polymorphic VT twisting around the baseline after QT-prolonging drugs is torsades; magnesium and correction of triggers are central.

Reference: ARC/ANZCOR ALS; Australian Medicines Handbook drug interaction guidance