Epiglottitis and torsade de pointes tachycardia.

Abstract

Severe throat infection is not usually associated with a higher risk of paroxysmal attacks of torsade de pointes tachycardia. A patient is reported in whom epiglottitis was associated with the sudden development of cardiac syncope caused by an acquired adrenergicdependent long QT syndrome and the development of ventricular arrhythmias. (Br Heart Y 1994;72:205-208) Case report A 70 year old man with a history of essential hypertension was admitted to the emergency ward with fever, dyspnoea, and severe throat pain. He had been treated with propranolol (80 mg daily), polythiazide (1 mg daily), and hydralazine (50 mg three times a day), during which time his electrocardiogram was normal (fig 1). Epiglottitis was diagnosed. In view of his severe respiratory distress, endotracheal intubation was performed and the patient was treated with mechanical ventilation for 10 days. A parapharyngeal abscess developed on aVL VI a ,1 i, III the right side of his neck. Computed tomography localised the abscess, surrounded by a severe inflammatory reaction, near the carotid artery and the sympathetic nerves on this side (fig 2). On the third day the abscess was drained through an incision along the sternocloidomastoid muscle, beneath the omohyoid muscle, and medial to the vessels. A digital dissection towards the abscess was performed. The patient was discharged from hospital after four weeks. Seven weeks later he was readmitted because of repeated transient sudden attacks of unconsciousness. During these attacks he had no signs of tonic or clonic movements or faecal or urinary incontinence. After each episode he felt exhausted and found it difficult to get up off the floor.No abnormalities were found on physical examination. Routine laboratory tests were normal with serum digoxin concentration of 1-9 nmol/l. A consultant neurologist found no signs of neurological deficits or neurological disease. Apart from a slightly enlarged heart, the chest x ray showed no other changes. Treatment with digitalis and propranolol was stopped.

Sudden death after major head and neck surgery

“…Torsades de pointe have been described after right pneumonectomy (in one case, postoperative myocardial I 131 scanning showed cardiac sympathetic nerve damage without coronary artery abnormalities [40]) and after an epiglottitis complicated with a right parapharyngeal abscess [41]. In these two case reports, cardiac arrhythmia was associated with a QT interval prolongation, diagnosed on the electrocardiogram.…”

Torsades de pointes tachycardia induced by common cold compound medication containing chlorpheniramine

“…Thus we cannot clarify the exact causal link between CPM intake and the occurrence of TdP. Especially, the underlying cold of the patient might have been jointly responsible for the QT prolongation [15][16][17].…”