Therefore, coronary angiography was deferred despite elevated biomarkers. Emergent transthoracic echocardiography revealed normal left ventricular systolic function with an ejection fraction of 60% by Simpson's biplane method, without segmental wall motion abnormalities. Electrocardiography (ECG) revealed a rate-corrected QT interval (QTc) of 517 ms with multifocal ventricular ectopy (Figure 1C). She was admitted with a primary diagnosis of cardiac arrest secondary to tetrafluoroethane inhalation. The patient was intubated and transferred to the intensive care unit and during transit, torsade de pointes recurred (Figure 1B), resolving spontaneously. Her laboratory analysis was notable for a normal serum sodium (140mEq/L) and a critically low serum potassium concentration of 2.6 mEq/L (normal range 3.5-4.5), high sensitivity troponin-I of 2,406 ng/L (reference range < 34 ng/L), and elevated serum lactate at 6.3 mmol/L (reference range 0.3-2.0 mmol/L), consistent with acidosis from resuscitated sudden cardiac death and resultant systemic hypoperfusion. In the ED, her physical examination was unrevealing. C, Twelve lead ECG with prolonged rate-corrected QT (QTc) interval of 517 ms and evidence of multifocal ventricular ectopy B, Telemetry strip upon transfer to the medical intensive care unit. Torsade de Pointes after Tetrafluoroethane Inhalation. According to acquaintance reports, the patient was huffing volatile chemicals just prior to her arrest. ![]() The patient had return of spontaneous circulation, but in the emergency department (ED) developed torsade de pointes (Figure 1A), which degenerated into ventricular fibrillation requiring defibrillation. Epinephrine 3mg and Amiodarone 450mg were administered as bolus therapy, and she was defibrillated thee time for persistent ventricular tachycardia. ![]() Emergency Medical Services arrived on the scene shortly thereafter, and she was found to be in ventricular fibrillation. Thus, we postulate that delayed repolarization with methamphetamine triggering may account for this arrhythmia.Ī 38-year-old woman with a past medical history of huffing-associated cardiac arrest was standing at the bus stop when she was witnessed to experience tonic-clonic seizure activity followed by collapse. Tetrafluoroethane, however, is chemically similar to chloroform (trichloromethane), which blocks the delayed rectifier potassium ion current (I kr). We are unaware of previous descriptions of torsade de pointes associated with volatile hydrocarbon inhalation or “huffing.” Although sudden death is associated with “huffing,” an arrhythmic mechanism has not been elucidated. Urine toxicology revealed methamphetamine. She had a prior hospitalization for cardiac arrest without rhythm documentation after inhaling a similar product. A patient presented with torsade de pointes after inhaling tetrafluoroethane, a volatile gas propellant used to clean keyboards.
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