R-on-T with massive ST-segment displacement unmasking dispersion of repolarisation associated with torsade de pointes

Abstract

A 70-year-old woman presented to the cardiac emergency department with recurrent nearcollapse. Two weeks before admission she had undergone mitral valve surgery for severe regurgitation. Physical examination revealed no significant abnormalities. The electrocardiogram showed sinus rhythm with low voltage P waves and incomplete right bundle branch block, and a severely prolonged QT interval of 660 ms at a heart rate of 56 beats/min, with negative T waves in the anterolateral leads (figure 1). Her medication on presentation consisted of digoxin 0.125 mg once daily and sotalol 80 mg three times a day.