Recipe for Torsades de Pointes.

Abstract

Mrs L is a 59-year-old woman transferred to the hospital from another facility due to increasing hypoxia resistant to treatment. It was felt that she had pneumonia. Her history is significant for end-stage renal disease, dialysis, amyloidosis; 2 months postautologous bone marrow transplant, left ventricular hypertrophy, and hypertension. Upon admission, she was examined by many services including pulmonology, cardiology, infectious disease, and nephrology. Each service added medications they felt would improve the health of the patient. Their combined efforts resulted in the patient being prescribed azithromycin (antibiotic), voriconazole (antifungal), and haldol (antipsychotic) all of which can prolong the QT interval. 1. 12 lead electrocardiograph (ECG) 2 months before admission showed QTc of 491 ms.