Torsades de pointes: Difference between revisions
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[[File:Torsades de Pointes TdP.png|thumb|12-lead ECG of Torsades de Pointes (TdP) in a 56-year-old white female with a potassium of 2.4 mmol/L and a magnesium of 1.6 mg/dL.]] | [[File:Torsades de Pointes TdP.png|thumb|12-lead ECG of Torsades de Pointes (TdP) in a 56-year-old white female with a potassium of 2.4 mmol/L and a magnesium of 1.6 mg/dL.]] | ||
*[[ECG]] | *[[ECG]] | ||
*BMP, Mg, Phos | |||
==Differential Diagnosis== | ==Differential Diagnosis== |
Revision as of 09:32, 13 April 2016
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.
Common Causes
POINTES mnemonic:
- Phenothiazines
- Other medications (ie TCAs)
- Intracranial bleed
- No known cause (idiopathic)
- Type I anti-arrhythmics (quinidine, procainamide, disopyramide)
- Electrolyte abnormalities (hypoK & hypoMag)
- Syndrome of Prolonged QT (aka Long QT Syndrome)
Clinical Features
Diagnosis
- ECG
- BMP, Mg, Phos
Differential Diagnosis
Treatment
Increasing HR decreases QT interval
- Magnesium sulfate - decreases calcium influx
- 1-2gm IV over 1-2 min, repeat in 5-15min; then 1-2gm/hr (3-10mg/min) gtt
- Danger of hypermagnesemia → depressed neuromuscular function, so monitor closely
- 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 > Ventricular pacing
- Goal HR 90-120
- Defibrillation / synchronized cardioversion - Patient in extremis
- AVOID amiodarone and procainamide, which may worsen prolonged QT