Torsades de pointes: Difference between revisions
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==Background== | ==Background== | ||
*Most commonly occurs in pts w/ prolonged QT due to heart diseaes or meds | *Most commonly occurs in pts w/ prolonged QT due to heart diseaes or meds. | ||
**Procainamide | **Procainamide | ||
**Phenothiazine | **Phenothiazine | ||
| Line 6: | Line 6: | ||
**Qunidine | **Qunidine | ||
**Disopyramide | **Disopyramide | ||
*'''POINTES''' mneumonic | |||
**'''P'''henothiazines | |||
**'''O'''ther medications (tricyclic antidepressants) | |||
**'''I'''ntracranial bleed | |||
**'''N'''o known cause (idiopathic) | |||
**'''T'''ype I anti-arrhythmics (quinidine, procainamide, dispyramide) | |||
**'''E'''lectrolyte abnormalities | |||
**'''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
- Magnesium - decreases calcium influx
- 1-2gm IV over 1-2 min, repeat in 5-15min; then 1-2gm/hr (3-10mg/min) gtt
- Danger of hyperMag2+ → depressed neuromuscular function
- Supplement with K+
- 1-2gm IV over 1-2 min, repeat in 5-15min; then 1-2gm/hr (3-10mg/min) gtt
- Isoproterenol - Increases HR / AV conduction
- 2-8 mcg/min
- Overdrive Pacing - Atrial over ventricular pacing
- Goal HR 90-120
See Also
Source
- Tintinalli