Abstract
A 55-year-old woman with a recent history of surgically and radioiodine treated thyroid
cancer experienced a run of polymorphic ventricular tachycardia with hemodynamic
perturbation during anaesthetic induction with propofol, fentanyl and rocuronium for
elective surgical excision of right hip metastasis. Electrocardiography showed new T-wave
inversion and QT prolongation that subsequently resolved. Cardiac enzymes were elevated
but invasive coronary angiography showed unobstructed epicardial coronary arteries.
Cardiovascular magnetic resonance showed not only normal biventricular size and systolic
function but also a striking pattern of patchy myocardial oedema involving the
basal-to-mid anterior, septal and inferior walls and some associated hypertrophy in the
anteroseptum (representing focal myocardial swelling from the oedema) but no focal or
diffuse myocardial fibrosis. All these abnormalities resolved on subsequent convalescent
imaging. A diagnosis of multifactorial acquired long QT syndrome secondary to atypical
variant stress-induced cardiomyopathy was made with the likely provoking factors in this
case having been the female sex, understandable pre-operative anxiety, anaesthetic drugs,
supraglottic airway placement and thyroid dysfunction. An implantable loop recorder during
follow-up detected no further significant arrhythmias and she remains well and
asymptomatic to date on a low dose of beta-blocker.