C-L Case Conference: Torsades de Pointes in a Patient with Lifelong Medical Trauma, COVID-19, Remdesivir, Citalopram, Quetiapine and Hemodialysis.

ABSTRACT

We present a case of Torsades de Pointes (TdP) in a patient with COVID-19 infection and multiple TdP risk factors including QTc prolongation, hemodialysis, bradycardia, and treatment with remdesivir, citalopram and quetiapine. The case was complicated by post-resuscitation anxiety superimposed on a history of medical trauma since childhood. Top experts in the field of consultation liaison psychiatry, trauma informed care (TIC) and cardiac electrophysiology provide perspectives on this case with a review of the literature. Key teaching topics include identification of TdP risk factors in patients with complex illness; the necessity for prompt electrophysiology consultation in clinical scenarios with high risk for TdP; and the approach to patients with medical trauma using a trauma-informed lens. We highlight the contributions of COVID-19, the pharmacokinetics of QTc-prolonging psychotropic medications, the risks of hemodialysis, and the role of remdesivir-induced bradycardia in this first reported case of TdP in a patient treated with remdesivir.