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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*Torsades de Pointes is a form of polymorphic VTach, where there is a gradual change in the amplitude and twisting of the QRS complexes around the isoelectric line
**Procainamide
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*Associated with prolonged QT, which may be congenital or acquired. '''POINTES''' mnemonic for common etiologies:
**Phenothiazine
 
**TCAs
 
**Qunidine
 
**Disopyramide
 
 
 
*'''POINTES''' mneumonic
 
 
**'''P'''henothiazines
 
**'''P'''henothiazines
**'''O'''ther medications (tricyclic antidepressants)
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**'''O'''ther medications (ie TCAs)
 
**'''I'''ntracranial bleed
 
**'''I'''ntracranial bleed
 
**'''N'''o known cause (idiopathic)
 
**'''N'''o known cause (idiopathic)
**'''T'''ype I anti-arrhythmics (quinidine, procainamide, dispyramide)
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**'''T'''ype I anti-arrhythmics (quinidine, procainamide, disopyramide)
 
**'''E'''lectrolyte abnormalities
 
**'''E'''lectrolyte abnormalities
 
**'''S'''yndrome of Prolonged QT (aka Long QT Syndrome)
 
**'''S'''yndrome of Prolonged QT (aka Long QT Syndrome)

Revision as of 04:59, 8 January 2014

Background

  • Torsades de Pointes is a form of polymorphic VTach, where there is a gradual change in the amplitude and twisting of the QRS complexes around the isoelectric line
  • Associated with prolonged QT, which may be congenital or acquired. POINTES mnemonic for common etiologies:
    • Phenothiazines
    • Other medications (ie TCAs)
    • Intracranial bleed
    • No known cause (idiopathic)
    • Type I anti-arrhythmics (quinidine, procainamide, disopyramide)
    • 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
  4. Synchronized Cardioversion - Pt in extremis

See Also

Source

  • Tintinalli