Torsades de pointes: Difference between revisions
(Content change) |
(Content rearrangement) |
||
Line 1: | Line 1: | ||
==Background== | ==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: | |||
**'''P'''henothiazines | **'''P'''henothiazines | ||
**'''O'''ther medications ( | **'''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, | **'''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
- 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
- Synchronized Cardioversion - Pt in extremis
See Also
Source
- Tintinalli