Faculty mentor/PI email address
jim010@aol.com
Is your research Teaching and Learning based?
1
Keywords
Methadone-associated QT prolongation, torsades de pointes, emergency department management, polymorphic ventricular tachycardia, malignant arrhythmia, cardiac arrest
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
We report a case of a 43-year-old female with cervical cancer and bilateral percutaneous nephrostomy tubes receiving high-dose methadone maintenance therapy who presented to the emergency department with bilateral flank and abdominal pain. She denied cardiac symptoms. Electrocardiogram obtained during evaluation revealed marked QT prolongation (QTc 596 ms) following recent methadone dose escalation. The patient was placed on continuous cardiac monitoring and intravenous magnesium was ordered. While intravenous access was being obtained, she developed polymorphic ventricular tachycardia consistent with torsades de pointes and became pulseless. Advanced cardiac life support was initiated including defibrillation and magnesium administration, with return of spontaneous circulation achieved. Methadone was discontinued and the patient was admitted to the intensive care unit, ultimately surviving to discharge. This case highlights the importance of early electrocardiographic evaluation and prompt monitoring in patients receiving high-risk medications such as methadone - even in the absence of primary cardiac complaints.
Disciplines
Cardiovascular Diseases | Medicine and Health Sciences | Neoplasms | Substance Abuse and Addiction
Included in
Cardiovascular Diseases Commons, Neoplasms Commons, Substance Abuse and Addiction Commons
Methadone-Associated QT Prolongation: The Importance of Early Recognition and Monitoring in the Emergency Department
We report a case of a 43-year-old female with cervical cancer and bilateral percutaneous nephrostomy tubes receiving high-dose methadone maintenance therapy who presented to the emergency department with bilateral flank and abdominal pain. She denied cardiac symptoms. Electrocardiogram obtained during evaluation revealed marked QT prolongation (QTc 596 ms) following recent methadone dose escalation. The patient was placed on continuous cardiac monitoring and intravenous magnesium was ordered. While intravenous access was being obtained, she developed polymorphic ventricular tachycardia consistent with torsades de pointes and became pulseless. Advanced cardiac life support was initiated including defibrillation and magnesium administration, with return of spontaneous circulation achieved. Methadone was discontinued and the patient was admitted to the intensive care unit, ultimately surviving to discharge. This case highlights the importance of early electrocardiographic evaluation and prompt monitoring in patients receiving high-risk medications such as methadone - even in the absence of primary cardiac complaints.