Huffing and Twist: Fatal Torsade de Pointes Associated with
A patient presented with torsade de pointes after inhaling
tetrafluoroethane, a volatile gas propellant used to clean keyboards.
She had a prior hospitalization for cardiac arrest without rhythm
documentation after inhaling a similar product. Urine toxicology
revealed methamphetamine. We are unaware of previous descriptions of
torsade de pointes associated with volatile hydrocarbon inhalation or
“huffing.” Although sudden death is associated with “huffing,” an
arrhythmic mechanism has not been elucidated. Tetrafluoroethane,
however, is chemically similar to chlorophorm (trichloromethane), which
blocks the delayed rectifier potassium ion current (Ikr). Thus, we
postulate that delayed repolarization with methamphetamine triggering
may account for this arrhythmia.