Syncope, seizure, or surprise? A teenager's school trip gone awry: case report of torsades de pointes and a review of long QT syndrome.

摘要

Torsades de pointes is a polymorphic ventricular tachycardia associated with a long QT interval with a variable presentation ranging from dizziness, syncope, or seizure, to sudden death. Frequently, torsades de pointes originates from a prolonged QT interval caused by premature ventricular depolarization occurring during repolarization.1 Recognizing torsades de pointes and the entities that lead to a prolonged QT interval, such as long QT syndrome LQTS, is essential for rendering appropriate life-saving therapy.A 13-year-old girl presented to the emergency department with several syncopal episodes while on a backpacking trip with her school classmates. She arrives with a note from her school principal stating that she has a history of syncope from orthostatic hypotension and hyponatremia. Over the past 2 days, she seemed to have fainted twice. Both episodes were associated with activity. In addition, she had a third episode that occurred while lying down in her sleeping bag, with jerking of the extremities and loss of consciousness that seemed to resemble a seizure. The patient arrived at our emergency department, asked to use the bathroom, and was taken by a nurse. While urinating, the patient suddenly became unresponsive, fell forward, and stiffened her neck, back, and upper body, with trembling of the arms and legs. The patient was taken to the resuscitation room; during transport, she regained consciousness.