Torsade de pointes: Difference between revisions

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* [[Cardiac enzymes]]
* [[Cardiac enzymes]]
* [[Echocardiography]] to rule out structural heart disease
* [[Echocardiography]] to rule out structural heart disease
==Treatment==
===Acute Treatment ===
If the episode of does not terminate on its own and degenerates into ventricular fibrillation,  [[cardioversion]] is required.
[[Image:Torsades_converted_by_AICD_ECG_strip_Lead_II.JPG|thumb|center|800px|Lead II [[electrocardiogram]] showing [[Torsades]] being shocked by an [[Implantable cardioverter-defibrillator]] back to the patients baseline [[cardiac rhythm]].]]
Once the patient is back in normal sinus rhythm, a vigorous search for and correction of  conditions that predispose to torsades de pointes which include [[hypokalemia]], [[hypomagnesemia]], and [[bradycardia]] should be made.  [[Magnesium sulfate]] (1-2 g IV over 30-60 seconds) reduces the influx of calcium thereby lowering the amplitude of early after depolarizations and should also be infused even if the magnesium is normal. <ref name="pmid15466950">{{cite journal |author=Hoshino K, Ogawa K, Hishitani T, Isobe T, Eto Y |title=Optimal administration dosage of magnesium sulfate for torsades de pointes in children with long QT syndrome |journal=J Am Coll Nutr |volume=23 |issue=5 |pages=497S–500S |year=2004 |month=October |pmid=15466950 |doi= |url=http://www.jacn.org/cgi/pmidlookup?view=long&pmid=15466950}}</ref><ref name="pmid16635167">{{cite journal |author=Hoshino K, Ogawa K, Hishitani T, Isobe T, Etoh Y |title=Successful uses of magnesium sulfate for torsades de pointes in children with long QT syndrome |journal=Pediatr Int |volume=48 |issue=2 |pages=112–7 |year=2006 |month=April |pmid=16635167 |doi=10.1111/j.1442-200X.2006.02177.x |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1328-8067&date=2006&volume=48&issue=2&spage=112}}</ref>
Administration of [[lidocaine]] is generally not effective, but mexiletene may be helpful in suppressing the recurrence of torsade de pointes.


==Additional Information==
==Additional Information==

Revision as of 01:54, 15 October 2012

Torsade de pointes
DiseasesDB 29252
MeSH D016171

Torsades de pointes Microchapters

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Overview

Historical Perspective

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Differentiating Torsades de pointes from other Diseases

Risk Factors

Natural History, Complications and Prognosis

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Electrocardiogram

EKG Examples

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]


Clinical Correlation

  1. Drugs: quinidine, PCA, norpace, amiodarone, phenothiazines, Tricyclic antidepressants, pentamidine.
    • with quinidine majority of the cases occur within one week of initiation, and with therapeutic levels
  2. Electrolyte imbalances: Hypokalemia, hypomagnesemia, hypocalcemia
  3. CAD
  4. MVP
  5. Variant angina
  6. Myocarditis
  7. Subarachnoid hemorrhage
  8. Congenital QT prolongation
  9. Liquid protein diets
  10. Hypothyroidism
    • because of bradycardia and a prolonged QT syndrome
  11. Organophosphate poisoning [1] [2]

Other lab studies

Additional Information

Examples

EKG's shown below are courtesy of C. Michael Gibson MS MD, and copylefted


Examples from different resources

  • Arrhythmias in a patient with short coupled torsade de pointes[3]

    Arrhythmias in a patient with short coupled torsade de pointes[3]

  • Arrhythmias in a patient with short coupled torsades de pointes degenerating in ventricular fibrillation[3]

    Arrhythmias in a patient with short coupled torsades de pointes degenerating in ventricular fibrillation[3]


  • Arrhythmias in a patient with short coupled torsade de pointes: frequent short coupled extrasystoles[3]

    Arrhythmias in a patient with short coupled torsade de pointes: frequent short coupled extrasystoles[3]

  • Arrhythmias in a patient with short coupled torsade de pointes: frequent short coupled extrasystoles [3]

    Arrhythmias in a patient with short coupled torsade de pointes: frequent short coupled extrasystoles [3]


  • A 12 lead ECG recording example of TdP[4]

    A 12 lead ECG recording example of TdP[4]


Characteristic tracing showing the "twisting" (blue line) of Torsade de pointes

References

  1. ↑ Chou's Electrocardiography in Clinical Practice Third Edition, pp. 398-409.
  2. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194 ISBN 1591032016
  3. ↑ 3.0 3.1 3.2 3.3 Leenhardt A, Glaser E, Burguera M, Nuernberg M, Maison-Blanche P, and Coumel P. Short-coupled variant of torsade de pointes. A new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias. Circulation 1994 Jan; 89(1) 206-15. PMID 8281648
  4. ↑ Khan IA. Twelve-lead electrocardiogram of torsade de pointes Tex Heart Inst J. 2001; 28 (1): 69. PMID 11330748

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