Erythromycin Torsade de Pointes

Report:

Sinus tachycardia 122/min

Nonspecific T wave changes

Prolonged QT interval

Comment:

This is one of those tracing where inspection is better than attempts at precise measurement and QTc calculation: there is a clear-cut long ST segment and the T wave, wherever it ends, is surely well beyond half-way between two QRS complexes.

The significance of this became obvious when typical torsades appeared (Fig 93a) below), half an hour after the 12-lead recording.

There is little doubt the episodes were due to erythromycin, given for a relatively trivial indication; they resolved with magnesium and stopping the antibiotic. Of all the macrolides, erythromycin is most likely to evoke this response63. Subsequent ECG was normal (Fig 93b).

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