Torsades de pointes - Revision history

Danbot: Strip excess bold text

2026-03-22T09:24:33Z

Strip excess bold text

← Older revision		Revision as of 09:24, 22 March 2026
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	===Common Causes===		===Common Causes===
	~~'''~~POINTES~~'''~~ mnemonic:		POINTES mnemonic:
	*[[Phenothiazines\|~~'''P'''henothiazines~~]]		*[[Phenothiazines\|Phenothiazines]]
	*~~'''O'''ther~~ medications (ie [[TCAs]])		*Other medications (ie [[TCAs]])
	*[[ICH\|~~'''I'''ntracranial~~ bleed]]		*[[ICH\|Intracranial bleed]]
	*~~'''N'''o~~ known cause (idiopathic)		*No known cause (idiopathic)
	*~~'''T'''ype~~ I [[antiarrhythmics]] ([[quinidine]], [[procainamide]], disopyramide)		*Type I [[antiarrhythmics]] ([[quinidine]], [[procainamide]], disopyramide)
	*[[electrolyte Abnormality\|~~'''E'''lectrolyte~~ abnormalities]] ([[hypokalemia\|hypoK]] & [[hypomagnesemia\|hypoMg]])		*[[electrolyte Abnormality\|Electrolyte abnormalities]] ([[hypokalemia\|hypoK]] & [[hypomagnesemia\|hypoMg]])
	*~~'''S'''yndrome~~ of [[Prolonged QT]] (aka Long QT Syndrome)		*Syndrome of [[Prolonged QT]] (aka Long QT Syndrome)
	*Other causes:		*Other causes:
	**[[Organophosphate toxicity]]		**[[Organophosphate toxicity]]
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	#*Note: Not a treatment for TdP, but useful in maintaining sinus rhythm		#*Note: Not a treatment for TdP, but useful in maintaining sinus rhythm
	#[[Defibrillation]] / [[synchronized cardioversion]] - Patient in extremis		#[[Defibrillation]] / [[synchronized cardioversion]] - Patient in extremis
	#~~'''~~AVOID~~'''~~ amiodarone and procainamide, which may worsen prolonged QT		#AVOID amiodarone and procainamide, which may worsen prolonged QT
	# [[Lidocaine]] (a class Ib antiarrhythmic drug) shortens the QT interval and may be effective especially for drug-induced torsades de pointes		# [[Lidocaine]] (a class Ib antiarrhythmic drug) shortens the QT interval and may be effective especially for drug-induced torsades de pointes
	#*[[Lidocaine]] 1 mg/kg bolus, followed by 0.5-4 mg/min, titrated to rhythm response<ref>Reachi B, Negrelli J, Hickman A, Beesley S, Osborn J (2019) Isoproterenol and Lidocaine for Recurrent Torsades de Pointes in a 32-year-old Pregnant Woman. Int J Crit Care Emerg Med 5:092.</ref>		#*[[Lidocaine]] 1 mg/kg bolus, followed by 0.5-4 mg/min, titrated to rhythm response<ref>Reachi B, Negrelli J, Hickman A, Beesley S, Osborn J (2019) Isoproterenol and Lidocaine for Recurrent Torsades de Pointes in a 32-year-old Pregnant Woman. Int J Crit Care Emerg Med 5:092.</ref>

Danbot: Add MedicationDose entries (magnesium sulfate, isoproterenol) with SMW annotations

2026-03-20T18:34:49Z

Add MedicationDose entries (magnesium sulfate, isoproterenol) with SMW annotations

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 #*[[Lidocaine]] 1 mg/kg bolus, followed by 0.5-4 mg/min, titrated to rhythm response<ref>Reachi B, Negrelli J, Hickman A, Beesley S, Osborn J (2019) Isoproterenol and Lidocaine for Recurrent Torsades de Pointes in a 32-year-old Pregnant Woman. Int J Crit Care Emerg Med 5:092.</ref>
 #*Inpatient may monitor plasma lidocaine levels, with goal < 6 mcg/mL
 ==Disposition==

Rossdonaldson1: /* Evaluation */

2025-07-30T16:50:47Z

Evaluation

← Older revision		Revision as of 16:50, 30 July 2025
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	==Evaluation==		==Evaluation==
	[[File:Torsades de Pointes (polymorphic VT).svg\|~~Rorsades~~ de Pointes in a rhythm strip.]]		[[File:Torsades de Pointes (polymorphic VT).svg\|thumb\|Torsades de Pointes in a rhythm strip.]]
	[[File:12leadTorsade.jpg\|thumb\|Classic torsades in 12-lead]]		[[File:12leadTorsade.jpg\|thumb\|Classic torsades in 12-lead]]
	[[File:Torsades de Pointes TdP.png\|thumb\|Torsades de Pointes (TdP) in patient with a potassium of 2.4 mmol/L and a magnesium of 1.6mg/dL.]]		[[File:Torsades de Pointes TdP.png\|thumb\|Torsades de Pointes (TdP) in patient with a potassium of 2.4 mmol/L and a magnesium of 1.6mg/dL.]]

Rossdonaldson1: /* Evaluation */

2025-07-30T16:49:58Z

Evaluation

← Older revision		Revision as of 16:49, 30 July 2025
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	==Evaluation==		==Evaluation==
			[[File:Torsades de Pointes (polymorphic VT).svg\|Rorsades de Pointes in a rhythm strip.]]
			[[File:12leadTorsade.jpg\|thumb\|Classic torsades in 12-lead]]
			[[File:Torsades de Pointes TdP.png\|thumb\|Torsades de Pointes (TdP) in patient with a potassium of 2.4 mmol/L and a magnesium of 1.6mg/dL.]]
	===Workup===		===Workup===
	*[[ECG]]		*[[ECG]]
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	===Diagnosis===		===Diagnosis===
	~~[[File:12leadTorsade.jpg\|thumb\|Classic torsades in 12-lead]]~~
	~~[[File:Torsades de Pointes TdP.png\|thumb\|Torsades de Pointes (TdP) in patient with a potassium of 2.4 mmol/L and a magnesium of 1.6mg/dL.]]~~
	*[[ECG]] showing the QRS complexes “twisting” around the isoelectric line		*[[ECG]] showing the QRS complexes “twisting” around the isoelectric line

Rossdonaldson1: /* Management */

2022-09-07T22:10:16Z

Management

← Older revision		Revision as of 22:10, 7 September 2022
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	#[[Defibrillation]] / [[synchronized cardioversion]] - Patient in extremis		#[[Defibrillation]] / [[synchronized cardioversion]] - Patient in extremis
	#'''AVOID''' amiodarone and procainamide, which may worsen prolonged QT		#'''AVOID''' amiodarone and procainamide, which may worsen prolonged QT
	# Lidocaine (a class Ib antiarrhythmic drug) shortens the QT interval and may be effective especially for drug-induced torsades de pointes		# [[Lidocaine]] (a class Ib antiarrhythmic drug) shortens the QT interval and may be effective especially for drug-induced torsades de pointes
	#*Lidocaine 1 mg/kg bolus, followed by 0.5-4 mg/min, titrated to rhythm response<ref>Reachi B, Negrelli J, Hickman A, Beesley S, Osborn J (2019) Isoproterenol and Lidocaine for Recurrent Torsades de Pointes in a 32-year-old Pregnant Woman. Int J Crit Care Emerg Med 5:092.</ref>		#*[[Lidocaine]] 1 mg/kg bolus, followed by 0.5-4 mg/min, titrated to rhythm response<ref>Reachi B, Negrelli J, Hickman A, Beesley S, Osborn J (2019) Isoproterenol and Lidocaine for Recurrent Torsades de Pointes in a 32-year-old Pregnant Woman. Int J Crit Care Emerg Med 5:092.</ref>
	#*Inpatient may monitor plasma lidocaine levels, with goal < 6 mcg/mL		#*Inpatient may monitor plasma lidocaine levels, with goal < 6 mcg/mL

Rossdonaldson1: /* Management */

2022-09-07T22:09:36Z

Management

← Older revision		Revision as of 22:09, 7 September 2022
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	==Management==		==Management==
	Increasing HR decreases QT interval		''Increasing HR decreases QT interval''
	#[[Magnesium sulfate]] - decreases calcium influx		#[[Magnesium sulfate]] - decreases calcium influx
	#*1-2gm IV over 1-2 min, repeat in 5-15min; then 1-2gm/hr (3-10mg/min) drip		#*1-2gm IV over 1-2 min, repeat in 5-15min; then 1-2gm/hr (3-10mg/min) drip

Kfarzam: /* Background */

2022-08-18T07:17:33Z

Background

← Older revision		Revision as of 07:17, 18 August 2022
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	*Form of polymorphic [[VTach]]		*Form of polymorphic [[VTach]]
	**Gradual change in the amplitude of QRS complexes and twisting around isoelectric line		**Gradual change in the amplitude of QRS complexes and twisting around isoelectric line
	*Associated with congenital or acquired [[prolonged QT]]		*Associated with congenital or acquired [[prolonged QT]] which may be secondary to medications

	===Common Causes===		===Common Causes===

Elcatracho: /* See Also */

2021-02-20T18:46:48Z

Kxl328: /* Management */

2020-07-01T17:38:37Z

Management

← Older revision		Revision as of 17:38, 1 July 2020
Line 60:		Line 60:
	#[[Defibrillation]] / [[synchronized cardioversion]] - Patient in extremis		#[[Defibrillation]] / [[synchronized cardioversion]] - Patient in extremis
	#'''AVOID''' amiodarone and procainamide, which may worsen prolonged QT		#'''AVOID''' amiodarone and procainamide, which may worsen prolonged QT
	# Lidocaine (a class Ib antiarrhythmic drug) shortens the QT interval and may be effective especially for drug-induced torsades de pointes.		# Lidocaine (a class Ib antiarrhythmic drug) shortens the QT interval and may be effective especially for drug-induced torsades de pointes
			#*Lidocaine 1 mg/kg bolus, followed by 0.5-4 mg/min, titrated to rhythm response<ref>Reachi B, Negrelli J, Hickman A, Beesley S, Osborn J (2019) Isoproterenol and Lidocaine for Recurrent Torsades de Pointes in a 32-year-old Pregnant Woman. Int J Crit Care Emerg Med 5:092.</ref>
			#*Inpatient may monitor plasma lidocaine levels, with goal < 6 mcg/mL

	==Disposition==		==Disposition==

ClaireLewis: /* Common Causes */

2019-09-26T18:31:50Z

Common Causes

← Older revision		Revision as of 18:31, 26 September 2019
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	===Common Causes===		===Common Causes===
	'''POINTES''' mnemonic:		'''POINTES''' mnemonic:
	*'[[Phenothiazines\|''P'''henothiazines]]		*[[Phenothiazines\|'''P'''henothiazines]]
	*'''O'''ther medications (ie [[TCAs]])		*'''O'''ther medications (ie [[TCAs]])
	*[[ICH\|'''I'''ntracranial bleed]]		*[[ICH\|'''I'''ntracranial bleed]]

← Older revision		Revision as of 18:46, 20 February 2021
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	*[[Tachycardia (Wide)]]		*[[Tachycardia (Wide)]]
	*[[ACLS (2010 Guidelines)]]		*[[ACLS (2010 Guidelines)]]
			*[[In-Training Exam Review]]

	==References==		==References==