What is a cause of torsade de point?

Common causes for torsades de pointes include drug-induced QT prolongation and less often diarrhea, low serum magnesium, and low serum potassium or congenital long QT syndrome. It can be seen in malnourished individuals and chronic alcoholics, due to a deficiency in potassium and/or magnesium.

How is torsade de point treated?

Treatment of torsade de pointes includes: isoproterenol infusion, cardiac pacing, and intravenous atropine. Intravenous magnesium sulfate, a relatively new mode of therapy for torsade de pointes, was proven to be extremely effective and is now regarded as the treatment of choice for this arrhythmia.

Does torsade de pointes go away?

Most cases of torsades de pointes resolve on their own without treatment. However, it can develop into ventricular fibrillation, which can lead to cardiac arrest and may even be fatal.

What medications cause torsades Depointes?

The list of drugs known to cause TdP that require a dose adjustment for patients with acute kidney injury or chronic kidney disease include: ciprofloxacin, disopyramide, dofetilide, flecainide, fluconazole, levofloxacin, procainamide, and sotalol.

Can you shock torsades?

Pulseless torsades should be defibrillated. Intravenous magnesium is the first-line pharmacologic therapy in Torsades de Pointes. Magnesium has been shown to stabilize the cardiac membrane, though the exact mechanism is unknown.

How do you reverse torsades de pointes?

Immediate treatment of TdP is by intravenous administration of magnesium sulphate, terminating prolonged episodes using electrical cardioversion. In refractory cases of recurrent TdP, the arrhythmia can be suppressed by increasing the underlying heart rate using isoproterenol (isoprenaline) or transvenous pacing.

Can you feel Torsades de Pointes?

You may suddenly feel your heart beating faster than normal, even when you’re at rest. In some TdP episodes, you may feel light-headed and faint. In the most serious cases, TdP can cause cardiac arrest or sudden cardiac death. It’s also possible have an episode (or more than one) that resolves quickly.

Can you have a pulse with torsades?

Patients with torsade may be hypotensive, have a rapid pulse and have loss of consciousness.

What does mag sulfate do to torsades?

Magnesium sulphate suppresses torsade by decreasing the influx of calcium ions, which in turn results in decreased amplitude of EADs. The initial dose is 2 g (20 ml of 10% solution), given intravenously over one to two minutes.

What medication do you give for torsades?

Intravenous magnesium is the first-line pharmacologic therapy in Torsades de Pointes. Magnesium has been shown to stabilize the cardiac membrane, though the exact mechanism is unknown. The recommended initial dose of magnesium is a slow 2 g IV push.

How fast do you push magnesium in torsades?

Magnesium can be given at 1-2 g IV initially in 30-60 seconds, which then can be repeated in 5-15 minutes. Alternatively, a continuous infusion can be started at a rate of 3-10 mg/min.

How do you reverse prolonged QT?

Beta blockers. These heart drugs are standard therapy for most patients with long QT syndrome. They slow the heart rate and make long QT episodes less likely. Beta blockers used to treat long QT syndrome include nadolol (Corgard) and propranolol (Inderal LA, InnoPran XL).

Do you shock torsades?

Do you defibrillate torsades with a pulse?

Treat the ventricular tachycardia Torsades de pointes is a ventricular tachycardia. In the unstable patient, cardiovert. In the pulseless, defibrillate. (The polymorphic nature of the rhythm may interfere with the defibrillator’s ability to synchronize, so cardioversion may not be possible.

What happens to the heart during torsades de pointes?

In the case of torsades de pointes (TdP), the heart’s two lower chambers, called the ventricles, beat faster than and out of sync with the upper chambers, called the atria. An abnormal heart rhythm is called an arrhythmia. When the heart beats much faster than normal, the condition is called tachycardia.

Does a pacemaker prevent torsades?

The pacemaker component of such devices should in theory help prevent torsades by preventing bradycardia. However, the rate of most pacemakers is not likely to provide protection from torsades.

How does magnesium help prolonged QT?

While potassium short- ens QTc interval, magnesium suppresses recurrent TdP without shortening QTc2,8,9,10,11. If TdP occurs, 1-2g of IV magnesium should be administered and repeated if necessary. The use of magnesium prophylactically for long QT with no TdP is debated and not well studied2,12.

Is there a pulse with torsades?

The physical findings in torsade depend on the rate and duration of tachycardia and the degree of cerebral hypoperfusion. Findings include rapid pulse, low or normal blood pressure, or transient or prolonged loss of consciousness.

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