What are these bizarre bigeminal PVCs??

Case 1

This ECG was texted to me last week with the question: "What is this??"

What do you think?

My answer: "This is a pre-torsades EKG. Watch out!  Every other beat, a PVC, has an extremely long QT.   In my experience, patients with ECGs like this are at very high risk of TORSADES. I have seen this several times." 

Outcome

It came from a patient who had been falling much, had a K of 2.8, and is on methadone but taking too much.  The patient then received K and Mg.  Torsades did not ensue.  The ECG findings resolved after metabolism of methadone and K replenishment. 

See several similar cases below, all of which were recorded before, during, or after Torsades de Pointes.

Case 2.  Polymorphic Ventricular Tachycardia

This patient was also on Methadone.  She had this 12-lead recorded immediately before the above one:

Torsades de Pointes

Case 3

Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management

Case 3, 8 minutes later

Case 3, later

Case 3, later

Case 3, later

Case 3, later

Case 3, later

Case 4, had Torsades after these ECGs

Same patient as "case 4," a bit later

See these posts:

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

Polymorphic Ventricular Tachycardia