Symptoma

Torsade de Pointes

Implantation of a pacemaker should be considered if bradycardia is present. [flexikon.doccheck.com]

It may be congenital, but it is more commonly acquired; medications, hydroelectrolyte alterations, and neurological, cardiac, and (more rarely) endocrine disorders are its most frequent causes. 1,2 We present the case of a male patient 68 years of age [revespcardiol.org]

In most reported cases at least one additional risk factor was present and in 70% of cases two risk factors were present. 1 Most risk factors are continuous variables, for instance the risk from hypokalaemia increases as potassium levels fall. [medsafe.govt.nz]

Torsades is a life-threatening arrhythmia and may present as sudden cardiac death in patients with structurally normal hearts. [patient.info]

Figure 1: Electrocardiogram at time of presentation demonstrating marked QTc interval prolongation. The history was notable for severe constipation and no bowel movement during the 7 days prior to presentation. [innovationsincrm.com]

  • Congestive Heart Failure

    Dofetilide in patients with congestive heart failure and left ventricular dysfunction. N Engl J Med. 1999 ; 341 : 857–865. Crossref Medline Google Scholar 40 Murray KT. Ibutilide. Circulation. 1998 ; 97 : 493–497. [ahajournals.org]

    Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish investigations of arrhythmia and mortality on dofetilide study group. N Engl J Med. 1999; 341 :857–865. [ PubMed ] [ Google Scholar ] 26. [ncbi.nlm.nih.gov]

  • Asymptomatic

    One month after discharge, the patient returned for a routine defibrillator checkup, and we witnessed AF with a QTc of 412 ms; he remained asymptomatic and had not presented arrhythmias. Figure 2. Cerebral MRI showing empty silla turcica (arrow). [revespcardiol.org]

    Asymptomatic male LQTS patients particularly associated with the C-terminal and haploinsufficient LQT1 mutations are at a much lower risk. [thecardiologyadvisor.com]

  • Collapse

    Torsades de pointes Clinical Significance TdP is often short lived and self terminating, however can be associated with hemodynamic instability and collapse. TdP may also degenerate into ventricular fibrillation (VF). [litfl.com]

  • Weakness

    However, it is difficult to remember all of these drugs, particularly those noncardiac and weak QT prolonging agents. There are a number of websites where physicians can search online for QT prolonging and other contraindicated medications. [thecardiologyadvisor.com]

  • Dizziness

    Symptoms • Patients with torsades usually present with recurrent episodes of palpitations, dizziness, and syncope. Sudden cardiac death can occur with the first episode. • Nausea, cold sweats, shortness of breath and chest pain may occur. 14. [de.slideshare.net]

    Symptoms of torsades de pointes include: heart palpitations dizziness nausea cold sweats chest pain shortness of breath rapid pulse low blood pressure In more serious cases, torsades de pointes can cause lack of consciousness, known as syncope, or even [medicalnewstoday.com]

    It is universally associated with congenital or acquired long QTc syndrome (LQTS). 1 Although it is often self limiting and associated with dizziness or syncope, ventricular tachycardia or ventricular fibrillation can occur resulting in sudden cardiac [emj.bmj.com]

    Patients with torsades usually present with recurrent episodes of palpitations, dizziness, and syncope. [ 7 ] Sudden cardiac death can occur with the first episode. Nausea, pallor, cold sweats, shortness of breath and chest pain may occur. [patient.info]

  • Vertigo

    Typical symptomes include vertigo, syncopation and nausea. [flexikon.doccheck.com]

  • Prolonged QT Interval

    These patients would only have symptoms or detected prolonged QT interval when exposed to stimulants like medications, acute illness or electrolyte disturbances. [onlinejacc.org]

    • Torsades de pointes is associated with long QT syndrome, a condition whereby prolonged QT intervals are visible on the ECG 4. Normal ECG 5. QT interval prolongation 6. QT prolongation leading to Tdp 7. The steps of repolarization 8. [de.slideshare.net]

    Torsade is associated with a prolonged QT interval, which may be congenital or acquired (for example, due to medications, hypokalemia, or hypomagnesemia). [emdocs.net]

    When using hydroxyzine: do not prescribe hydroxyzine to people with a prolonged QT interval or who have risk factors for QT interval prolongation (see below) avoid use in the elderly - they are more susceptible than younger patients to the side effects [gov.uk]

    A prolonged QT interval in the surface electrocardiogram is the sine qua non of the LQTS and is a surrogate measure of the ventricular action potential duration (APD). [onlinelibrary.wiley.com]

In bad cases the torsade de pointes can turn into ventricular fibrillations which can end deadly. 4 Treatment In case the torsade de pointes persists, the acute treatment should be cardioversion. [flexikon.doccheck.com]

Treatment In some cases, torsades de pointes will just be monitored rather than treated. Torsades de pointes can have life-threatening complications, so immediate treatment is vital. [medicalnewstoday.com]

Cocaine Electrolyte abnormalities (hypokalaemia, hypomangesaemia) SAH Treatment Aim of treatment in TdP : To treat haemodynamic compromise immediately. To alter the after-depolarisation effect. To shorten the QT interval. [emed.ie]

Long-term treatment Patients without syncope, ventricular tachyarrhythmia or a family history of sudden cardiac death can be observed without starting any treatment. [patient.info]

Percutaneous overdrive pacing in the out-of-hospital treatment of Torsade de Pointes. Ann Emerg Med 1999 ; 33 : 356 –7. [emj.bmj.com]

In acquired long QT syndrome, the prognosis is excellent once the inciting factor has been identified and reliably withheld. Patient education Instruct patients to use medications only with the approval of a physician. [emedicine.medscape.com]

In acquired long QT syndrome, the prognosis is excellent once any precipitating factor has been removed. Prevention [ 9 ] Avoid offending drugs that prolong the QT interval. [patient.info]

Conclusion LVNC is often difficult to diagnose, but a high degree of clinical awareness is necessary due to its poor prognosis. [revportcardiol.org]

Although the likelihood of TdP-mediated cardiac events such as syncope and cardiac arrest is generally low in infants, occurrence of such events in the first 5 years of life indicates one of the severe LQTS genotypes and has a relatively poor prognosis [thecardiologyadvisor.com]

However, long QT complicating AVB, with concomitant ventricular arrhythmias such as TdP, is also frequently seen in association with conduction disturbances of any etiology, and may be aggravated by the presence of LVNC for the reasons described above [revportcardiol.org]

Epidemiology [ 3 ] The corrected QT interval is longer in the white population than in the black population, and longer in females than males. [patient.info]

Further review of the causes of QT prolongation Pathophysiology of TdP A prolonged QT reflects prolonged myocyte repolarisation due to ion channel malfunction. [litfl.com]

Pharmacotherapy: A Pathophysiological Approach. 6th ed. New York, NY: McGraw-Hill Medical; 2005:347. 5. Straus SM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. [uspharmacist.com]

Although QT prolongation and TdP can be acquired due to use of certain drugs and a variety of pathophysiological conditions such as electrolyte disturbances, ventricular hypertrophy, and Takotsubo cardiomyopathy, the term “LQTS” is normally used to refer [thecardiologyadvisor.com]

Since LCSD is an invasive procedure, it should be used as a secondary prevention modality. [thecardiologyadvisor.com]

Be prepared to intubate Prevent torsades from recurring Converting the patient out of torsades de pointes is only the first step. The underlying cause will still be present and therefore the rhythm is likely to recur. [first10em.com]

Prevention [ 9 ] Avoid offending drugs that prolong the QT interval. Prevent predisposing conditions such as hypokalaemia, hypomagnesaemia, and hypocalcaemia, especially in patients shown to have long QT interval. [patient.info]

Initiation of a protocolized magnesium infusion immediately following the first episode of TdP may prevent recurrence and thereby avoid complications (e.g. cardiac arrest, rib fractures). [emcrit.org]

How to prevent arrhythmia in these patients remains unclear. Conclusion Though small in number, patients with undefined channelopathies may develop life-threatening arrhythmia if exposed to stimulants. [onlinejacc.org]