Snapshot A man with a family history of sudden cardiac death is brought in by EMS after collapsing on the basketball court. His EKG tracing from the EMS team is shown. Introduction A form of polymorphic ventricular tachycardia early after depolarization progressive, sinusoidal, cyclic alteration of the QRS axis peaks of QRS seem to "twist" Causes include hypomagnesemia, hypokalemia, hypocalcemia prolonged QT interval due to any cause includes Class IA and Class III antiarrhytmics (except amiodarone), tricyclic antidepressants congenital long QT syndromes Jervell and Lange-Nielsen syndrome due to defects in cardiac sodium or potassium channels can be associated with congenital sensorineural deafness Presentation Symptoms/Physical exam syncope palpitations cardiogenic shock sudden cardiac death Evaluation ABCs with advanced cardiac life support Treatment Often shortlived and self-terminating Discontinue all QT prolonging drugs Defibrillation If hypokalemic magnesium sulfate If refractory isoproterenol transvenous pacing