Case Report Idiopathic Intractable Diarrhoea Leading to Torsade de Pointes Kyriacos Mouyis, 1 Darlington Okonko, 2 and Constantinos G. Missouris 1 1 Frimley Health NHS Foundation Trust, Wexham Park Hospital, Cardiology Department, Slough SL2 4HL, UK 2 King’s College London BHF Centre, King’s College Hospital, London SE1 7EH, UK Correspondence should be addressed to Constantinos G. Missouris; dinos.missouris@ff.nhs.uk Received 23 February 2016; Revised 24 April 2016; Accepted 26 April 2016 Academic Editor: Kjell Nikus Copyright © 2016 Kyriacos Mouyis et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. An 81-year-old lady was admitted to our hospital with a 3-year history of noninfective diarrhoea and recurrent syncopal events over the last 3 months. Her initial electrocardiogram (ECG) revealed trigeminy and prolonged QTc interval. She had a structurally normal heart with no coronary artery disease. Investigations revealed low potassium at 3.0 mmol/L. Sigmoidoscopy and colonoscopy suggested a possible diagnosis of diverticulitis. Soon afer admission she had an unresponsive episode with spontaneous recovery. Telemetry and Holter analysis confrmed multiple episodes of polymorphic ventricular tachycardia (Torsade de Pointes). Following electrolyte supplementation the episodes of polymorphic VT improved. Due to the protracted nature of the diarrhoea, the recurrent syncopal events, and recurrent hypokalaemia documented over recent years, an Implantable Cardioverter Defbrillator (ICD) was sanctioned by the multidisciplinary team (MDT). In summary, chronic diarrhoea may result in life threatening polymorphic VT due to hypokalaemia and QTc prolongation. In these patients an ICD may be considered. 1. Introduction Electrolyte abnormalities are common in patients with pro- longed diarrhoea. We report the case of a lady, the frst we are aware of, who sufered from hypokalaemia and a history of recurrent syncopal events related to Torsades de Pointes as a result of persistent and intractable diarrhoea. 2. Case Presentation An 81-year-old lady was admitted to our hospital with recurrent falls associated with brief loss of consciousness. She denied any other cardiac symptoms. Her past medical history included an embolic cerebrovascular event a year earlier with no residual focal neurology, hypertension, treated hypothyroidism, diverticulosis, anaemia of chronic disease, and chronic noninfective diarrhoea of 3 years’ duration. Tis had been extensively investigated by several gastroenterolo- gists and colorectal surgeons. On admission she was passing 8–10 loose motions a day. She was on treatment with levothyroxine 125 micrograms OD, clopidogrel 75 mg OD, aspirin 75 mg OD, atorvastatin 40 mg OD, ranitidine 150 mg BD, zopiclone 7.5 mg OD, citalopram 10 mg OD, folic acid 5 mg OD, loperamide 2 mg TDS, co-codamol 8/500 2 tablets QDS, and desloratadine 5 mg OD. On examination she was apyrexial, the pulse was 60 beats per minute and regular, and the supine blood pressure was 157/55mmHg. Saturation on air was 95%. Te rest of the cardiovascular, respiratory, and abdominal examination was within normal limits. Tere were no history of liquorice use, no clinical evidence of somatic neuropathy, and no evidence of adrenal adenomas on abdominal CT examination done prior to admission. Te investigations were as follows: haemoglobin 12.7 g/L, sodium 143 mmol/L, potassium 3.0 mmol/L, chloride 101 mmol/ L, bicarbonate 27.6 mmol/L, pH 7.46, magnesium 0.72 mmol/ L, adjusted calcium 2.21 mmol/L, phosphate 1.08 mmol/L, TSH 0.22 /mL, free T4 25 pmol/L, and C Reactive Protein (CRP) 89 mg/L. Te admission resting ECG revealed ven- tricular bigeminy and prolongation of the QTc at 519 msec (normal for females < 470 msec), measured using Bazett’s formula as heart rate was less than 65 bpm. Telemetry and Holter analysis confrmed the presence of multiple episodes of polymorphic VT (Torsades de Pointes) (Figure 1). An echocardiogram confrmed a structurally normal heart with Hindawi Publishing Corporation Case Reports in Cardiology Volume 2016, Article ID 3845108, 3 pages http://dx.doi.org/10.1155/2016/3845108