A patient arrives to the ER complaining on unusually rapid heart rate. History i

Question

A patient arrives to the ER complaining on unusually rapid heart rate. History is unremarkable with the exception of a recent usage of a “Z-pack” antibiotic (azithromycin) for sinus infection. His bloodwork shows mild hypomagnesemia. While at the ER, the patient starts feeling dizzy, his blood pressure drops and he develops syncope. ECG is shown below.

1. What is your diagnosis?

2. What is the possible etiology?

3. What is the conduction abnormality that this patient likely has had but was unaware of?

4. What is the most likely outcome? If this condition persists, what is the possible worse outcome?

5. What kind of treatment would you recommend?

Explanation / Answer

1- Torsades de pointes.t here is twisting of QRS along isoelectric baseline

2-Hypomagnesemia

3-The patient has AV block which he is unaware of

4-in most cases,it everts to normal sinus rhythm.but if untreated,it causes ventricular fibrillation

5-in this case as it is due to hypomagnesemia,i.v magnesium should be infused and I.v atropine

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