Exercise Stress Test-Induced Torsade de Pointes: A Case Report

Torsade de pointes (TdP) is an infrequent, yet fatal ventricular arrhythmia as it may degenerate into sudden cardiac death. Given its lethality, it is important to understand its triggering factors and management. We report a rare case of TdP during an exercise stress test. A 64-year-old woman with controlled hypertension underwent an exercise stress test due to her atypical chest pain. She had no family history of sudden cardiac death. A baseline electrocardiogram showed an insignificant prolongation in her corrected QT (QTc) value (479 ms). During the second stage, she developed a transient TdP and was managed in the intensive care unit. A further examination showed moderate hypokalemia, and coronary angiography showed 90% to 95% stenosis in her right coronary artery. A follow-up exercise stress test after electrolyte replacement therapy and coronary revascularization showed a negative ischemic response without arrhythmia. TdP in this patient might have been related to 3 conditions: ischemic burden, hypokalemia, and exercise. Further examinations are needed to inform further management and preventive measures. (Iranian Heart Journal 2021; 22(4): 140-144)