Difference between revisions of "Torsades de pointes"

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==Background==
 
==Background==
*Most commonly occurs in pts w/ prolonged QT due to heart diseaes or meds:
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*Most commonly occurs in pts w/ prolonged QT due to heart diseaes or meds.
 
**Procainamide
 
**Procainamide
 
**Phenothiazine
 
**Phenothiazine
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**Qunidine
 
**Qunidine
 
**Disopyramide
 
**Disopyramide
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*'''POINTES''' mneumonic
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**'''P'''henothiazines
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**'''O'''ther medications (tricyclic antidepressants)
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**'''I'''ntracranial bleed
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**'''N'''o known cause (idiopathic)
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**'''T'''ype I anti-arrhythmics (quinidine, procainamide, dispyramide)
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**'''E'''lectrolyte abnormalities
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**'''S'''yndrome of Prolonged QT (aka Long QT Syndrome)
  
 
==Treatment==
 
==Treatment==

Revision as of 04:49, 8 January 2014

Background

  • Most commonly occurs in pts w/ prolonged QT due to heart diseaes or meds.
    • Procainamide
    • Phenothiazine
    • TCAs
    • Qunidine
    • Disopyramide
  • POINTES mneumonic
    • Phenothiazines
    • Other medications (tricyclic antidepressants)
    • Intracranial bleed
    • No known cause (idiopathic)
    • Type I anti-arrhythmics (quinidine, procainamide, dispyramide)
    • Electrolyte abnormalities
    • Syndrome of Prolonged QT (aka Long QT Syndrome)

Treatment

Increasing HR decreases QT interval

  1. Magnesium - decreases calcium influx
    1. 1-2gm IV over 1-2 min, repeat in 5-15min; then 1-2gm/hr (3-10mg/min) gtt
      1. Danger of hyperMag2+ → depressed neuromuscular function
      2. Supplement with K+
  2. Isoproterenol - Increases HR / AV conduction
    1. 2-8 mcg/min
  3. Overdrive Pacing - Atrial over ventricular pacing
    1. Goal HR 90-120

See Also

Source

  • Tintinalli