Torsades de pointes

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
4. Synchronized Cardioversion - Pt in extremis

See Also

• Tachycardia (Wide)
• ACLS (2010 Guidelines)

Source

• Tintinalli