Short QTc in Diltiezam Overdose
Report:
Junctional rhythm 56/min
Short QT interval 0.36”
QTc 0.35”
Lead V2 missing
Possible old inferior infarction.
Comment:
The cause of QT interval shortening is iatrogenic32 hypercalcæmia induced by calcium infusion for diltiezam overdose hypotension. Serum calcium peaked at 3.44 mmol/L.
The patient had a known inferior MI, but its evidence had dissipated over the years. This happens to at least 1/3 inferior MIs in time. Looking harder, there are puny q waves in 2 and aVF, with a QS in 3 - not exactly a proof. What supports the diagnosis is small voltage in the inferior leads and concordant T wave inversion in 3.
The inferior MI was well documented. The patient had CABGs to the left circumflex and left anterior descending arteries a year previously.
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