Repeatitive Idea A 42-year-old man arrives at the emergency department after experiencing syncope. He was standing in his kitchen this morning when he felt palpitations for about 3 seconds and then woke up on the floor. For the past few weeks, the patient has experienced intermittent palpitations, sometimes accompanied by lightheadedness. He has no significant medical history other than chronic lower back pain that began three years ago after falling from a ladder. In that fall, the patient fractured several lumbar vertebrae, necessitating surgical lumbar fusion. His back pain was uncontrollable with conservative measures, so he has been on escalating methadone doses for the past year. He does not smoke or consume alcoholic beverages. The patient has a remote history of intravenous heroin abuse but has not used it for 20 years. He has no family history of early-onset heart disease, blood clots, or sudden death. Blood pressure is 120/70 mm Hg when supine and 125/75 mm Hg when standing. Physical examination is unremarkable. Which of the following ECG findings is most likely in this patient?

Question

Repeatitive Idea A 42-year-old man arrives at the emergency department after experiencing syncope. He was standing in his kitchen this morning when he felt palpitations for about 3 seconds and then woke up on the floor. For the past few weeks, the patient has experienced intermittent palpitations, sometimes accompanied by lightheadedness. He has no significant medical history other than chronic lower back pain that began three years ago after falling from a ladder. In that fall, the patient fractured several lumbar vertebrae, necessitating surgical lumbar fusion. His back pain was uncontrollable with conservative measures, so he has been on escalating methadone doses for the past year. He does not smoke or consume alcoholic beverages. The patient has a remote history of intravenous heroin abuse but has not used it for 20 years.  He has no family history of early-onset heart disease, blood clots, or sudden death.  Blood pressure is 120/70 mm Hg when supine and 125/75 mm Hg when standing.  Physical examination is unremarkable.  Which of the following ECG findings is most likely in this patient?

Quizplus · Accepted Answer

Eductional Objective: Methadone reduces the delayed rectifier potassium current, which is responsible for ventricular repolarization, and high doses are linked to QT interval prolongation. QT interval prolongation increases the risk of developing torsade de pointes, a dangerous ventricular arrhythmia that can result in syncope and sudden cardiac death.

Repeatitive Idea a 42-Year-Old Man Arrives at the Emergency Department