Bidirectional ventricular tachycardia induced by respiratory alkalosis mediated hypokalemia in a patient with acute ischemic heart failure

Pacing Clin Electrophysiol. 2021 Dec;44(12):2115-2118. doi: 10.1111/pace.14337. Epub 2021 Aug 22.

Abstract

Bidirectional ventricular tachycardia (BVT) is a rare arrhythmia that is generally observed in patients with catecholaminergic ventricular tachycardia or digoxin overdose. Herein, we present a case of BVT and electrical storm (ES) in an acute ischemic heart failure patient that is typically induced by hypokalemia. The patient was in invasive mechanical ventilator (MV) support and hypokalemia was related to acute respiratory alkalosis and that caused refractory hypokalemia despite intravenous (IV) potassium replacement. We also discuss our approach to solve refractory hypokalemia caused by respiratory alkalosis.

Keywords: Bidirectional ventricular tachycardia; hypokalemia; mechanical ventilation; respiratory alkalosis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Alkalosis, Respiratory / complications*
  • Alkalosis, Respiratory / therapy
  • Electrocardiography
  • Female
  • Heart Failure / complications*
  • Heart Failure / therapy
  • Humans
  • Hypokalemia / complications*
  • Hypokalemia / therapy
  • Tachycardia / etiology*
  • Tachycardia / therapy

Supplementary concepts

  • Bidirectional tachycardia