Torsades de Pointes is a polymorphic ventricular tachycardia that manifests on ECG as oscillatory changes in the amplitude of QRS complexes around the isoelectric lines. Torsades de Pointes and QTc prolongationwhich is the heart rate adjusted prolongation of the QT interval.

What causes torsades de pointes?

Risk factors for torsion twist include:

• Congenital Long QT Syndrome.
• female gender.
• Acquired long QT syndrome (caused by medications and electrolyte disturbances such as hypokalemia and hypomagnesemia)
• Bradycardia.
• Baseline ECG abnormalities.
• Kidney or liver failure.

Who discovered torsades de pointes?

it is described as French doctor François Desseten in 1966. Prolonging the QT interval increases a person’s risk of developing this abnormal heart rhythm, which occurs in between 1% and 10% of patients receiving QT-prolonging antiarrhythmic drugs.

What is the best treatment for torsades de pointes?

Treatment of torsades de pointes includes: isoproterenol infusion, cardiac pacing, and intravenous atropine. Intravenous magnesium sulfatea relatively new modality for the treatment of torsades de pointes, has proven to be very effective and is now considered the treatment of choice for this arrhythmia.

Can you tolerate torsades de pointes?

Most cases of torsades de pointes resolves on its own without treatmentHowever, it can progress to ventricular fibrillation, which can lead to cardiac arrest, which can even be fatal.

Long QT syndrome and torsades de pointes, animation

25 related questions found

What does torsion ventricular tachycardia feel like?

Even when you are at rest, you may suddenly feel your heart beating faster than usual.In some TdP episodes, you may feel dizzy. In the most severe cases, TdP can cause cardiac arrest or sudden cardiac death. It’s also possible that one episode (or more than one) is resolved quickly.

Torsional VT is VT or VF?

Treatment of ventricular tachycardia and cardiac arrest

Polymorphic VT associated with a normal QT interval is most often caused by acute ischemia or infarction and may rapidly degenerate into VF. When polymorphic VT is associated with a long QT interval, the syndrome is called torsades de pointes (Figure 23-7).

Would you do CPR for Torsades?

If amiodarone is not available, lidocaine may be considered. Consider magnesium therapy for torsades de pointes associated with a long QT interval (see below). You should give it during CPRperform rhythm analysis as soon as possible.

Why is magnesium given for torsion ventricular tachycardia?

Magnesium is Drug of choice for suppression of early post-depolarization (EAD) and arrhythmia termination. Magnesium does this by reducing the influx of calcium, thereby reducing the magnitude of EAD. Magnesium can be given at 1-2 g IV initially over 30-60 seconds and then repeated over 5-15 minutes.

Which drug can cause torsades de pointes?

Other drugs that prolong the QT interval and are associated with torsades tachycardia include Phenothiazinestricyclic antidepressants, lithium carbonate, ziprasidone, cisapride, highly active antiretroviral drugs, high-dose methadone, anthracycline chemotherapy drugs (such as doxorubicin, daunorubicin), Some…

Do you defibrillate torsion ventricular fibrillation?

Pulseless torsion should be defibrillated. Intravenous magnesium is the first-line drug treatment in Torsades de Pointes. Magnesium has been shown to stabilize the pericardium, but the exact mechanism is unknown. The recommended initial magnesium dose is a slow 2 g intravenous bolus.

Can amiodarone cause torsades?

4 Amiodarone is presumed to have Low incidence of drug-induced torsades de pointes (TdP), incidence <0.5%.

Can hypocalcemia cause torsades?

Hypocalcemia is a common biochemical abnormality that can range in severity from mild asymptomatic to life-threatening crisis [1] in others. This is a very rare cause of torsades de pointes [2].

Which Medications Should I Avoid for Long QT Syndrome?

Psychotropic/antidepressant/anticonvulsant Antipsychotics (including thioridazine, haloperidol, chlorpromazine), antidepressants (including matriptyline, amitriptyline, imipramine, fluoxetine, desipramine, paroxetine) and the anticonvulsants felbamate and fosphenytoin.

Can you reverse ventricular fibrillation in shock?

Torsades de pointes is a ventricular tachycardia. In unstable patients, cardioversion. In the absence of a pulse, defibrillate. (Polymorphisms in the rhythm may interfere with the defibrillator’s ability to synchronize, so cardioversion may not be performed.

What are the signs of low magnesium levels in the body?

A: One of the first signs of magnesium deficiency is usually fatigue. You may also notice muscle cramps, weakness, or stiffness. Loss of appetite and nausea are other common symptoms in the early stages. However, you may not notice any symptoms at all at first.

How do you know if you have torsades de pointes?

Torsade de pointes can be diagnosed by evaluating an individual’s calcium, magnesium, and potassium levels, but the best way to diagnose this condition is Via electrocardiogram (EKG). The ECG measures the currents in the heart and displays them as waves (wavy lines) on the screen.

Does magnesium shorten the QT interval?

Magnesium supplementation did not shorten the QT interval There was no significant correlation between Mg levels and QTc interval. Patients with a history of syncope had higher MgR levels (syncope(+):syncope(-) = 70:46%, p < 0.01), and intravenous magnesium ameliorated magnesium deficiency.

What drugs are given during CPR?

epinephrine Still the drug of choice during CPR, other drugs such as atropine, sodium bicarbonate, calcium, magnesium, and fibrinolytic drugs should only be considered in specific circumstances.

Are you using a pulse shock for VT?

According to current resuscitation guidelines, symptomatic ventricular tachycardia (VT) with a palpable pulse is processed Synchronized cardioversion was performed to avoid induction of ventricular fibrillation (VF), whereas pulseless VT was treated as VF, and full defibrillation energy was rapidly administered asynchronously to shocks.

What are the 4 shocking rhythms?

Shocking rhythm: ventricular tachycardia, ventricular fibrillationSupraventricular tachycardia.

Why does hypocalcemia lead to long QT?

Hypocalcemia is a well-established cause of QT prolongation by prolonging the plateau of the cardiac action potential.This causes Calcium channels stay open longerallowing the formation of late calcium influx and early post-depolarization.

What ECG findings are seen in hypocalcemia?

ECG features of hypocalcemia persist QTc prolongation due to ST segment prolongation, which is proportional to the degree of hypocalcemia or, as otherwise stated, inversely proportional to serum calcium levels. Hypercalcemia is the exact opposite.

Does low potassium cause QTc prolongation?

potassium level below 3,0 mmol/l Leads to significant QT prolongation with subsequent risk of torsades de pointes, ventricular fibrillation, and sudden cardiac death.