Torsades de pointes: Difference between revisions

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#Magnesium - decreases calcium influx
#Magnesium - decreases calcium influx
##1-2gm IV over 1-2 min, repeat in 5-15min; then 1-2gm/hr (3-10mg/min) gtt
##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
###Danger of hyperMag2+ → depressed neuromuscular function, so monitor closely
###Supplement with K+
###Supplement with K+
#Isoproterenol - Increases HR / AV conduction
#Isoproterenol - Increases HR / AV conduction
##2-8 mcg/min
##2-8 mcg/min
#[[Overdrive Pacing]] - Atrial over ventricular pacing
#[[Overdrive Pacing]] - Atrial > Ventricular pacing
##Goal HR 90-120
##Goal HR 90-120
#Synchronized Cardioversion - Pt in extremis
#Synchronized Cardioversion - Pt in extremis

Revision as of 05:00, 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, so monitor closely
      2. Supplement with K+
  2. Isoproterenol - Increases HR / AV conduction
    1. 2-8 mcg/min
  3. Overdrive Pacing - Atrial > Ventricular pacing
    1. Goal HR 90-120
  4. Synchronized Cardioversion - Pt in extremis

See Also

Source

  • Tintinalli