Correcting the QTc and fixing torsade’s, what can’t steroids do!

Abstract

Introduction: Long QT syndrome (LQTS) is the congenital or acquired prolongation of the QT interval on an electrocardiogram (ECG). It is well-known that the QT interval is prolonged in adrenal insufficiency (AI) but rarely prolonged enough to cause Torsade de Pointes (TdP). Case Report: Here we report a case of TdP and cardiac arrest in a patient with adrenal insufficiency. The patient had a return of spontaneous circulation after a successful cardiopulmonary resuscitation (CPR). Electrocardiograms persistently showed prolonged QT corrected for heart rate (QTc) prior to and at the time of cardiac arrest, some exceeding 600 milliseconds (ms). The QT interval improved significantly upon administration of steroids and the episodes of TdP resolved. Conclusion: This case highlights the importance of recognizing adrenal insufficiency (AI) as a potentially reversible cause of prolonged QT and TdP.