Clinical Practice and Cases in Emergency Medicine

Torsades de Pointes (TdP) is a polymorphic ventricular tachycardia that occurs in the presence of anacquired or congenital long QT syndrome (LQTS). We present the case of a 57 year-old man withend-stage renal disease on methadone maintenance in which there occurred multiple episodes of TdPduring sleep. The patient was found to have a QTc interval of 548 milliseconds, and the dysrhythmiawas successfully treated with isoproterenol infusion and methadone substitution. It is surmised that thepatient had a multifactorial, acquired LQTS that during somnolence, reached a critical threshold of QTprolongation to lead to the development of TdP.