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Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
KIMS, Kollam
India
editor
Torsades de pointes is a variant of polymorphic VT.
The ECG shows rapid irregular complexes that oscillate from an upright to an inverted position and seem to twist around the baseline as the mean QRS axis change.
They are usually non sustained and repetitive but may degrade into ventricular fibrillation.
Torsades de pointes is usually initiated by a VPB starting at the peak of a prolonged T-U wave.
Etiology
Acquired Long QT Syndrome
Drugs: Quinidine, ibutilide, sotalol, procainamide,amiodarone, tricyclic antidepressants, other drugs like pentamadine, erythromycin.
Electrolyte imbalance: Hypokalemia,hypomagnesemia and less commonly hypocalcemia.
High grade AV Heart Block
Subarachnoid hemorrhage
Hereditary Long QT Syndrome
Jervell and Lange Nielsen Syndrome
Romano-Ward Syndrome
Note the twisting around the baseline where QRS axis changes
Management
Magnesium
ACLS guidelines recommends to use 1 – 2gm of magnesium sulphate in 10 ml 5% D.
Studies have shown that administration of magnesium sulfate can facilitate termination of torsades de pointes. It is not likely to be effective in terminating irregular/polymorphic VT in patients with a normal QT interval.
It is administrated over 15 minutes.
Updated on 2/2/2015
Reference
Tintinalli
Davidson
Goldberger's Clinical Electrocardiography
2010 AHA Guideliones for CPR and emergency cardiovascular care. Part 8. ACLS
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
KIMS, Kollam
India
editor