###### Created: 2024-06-12 19:35 ###### Areas & Topics: #medicine #cardiovascular ###### Note Type: #permanent ###### Connected to: [[Adult Advanced Life Support (AALS)]] [[Peri-Arrest Rhythms]] - Torsades de Pointes comes from French, meaning 'twisting of the point'. - This refers to its appearance on ECG of 'twisting' around the isoelectric line. - It is a form of polymorphic ventricular tachycardia, which occurs secondary to a long QT interval (see [[Long QT Syndrome]]). - It is typically self-limiting, but can be recurrent and lead to impairment and syncope. - It can deteriorate into ventricular fibrillation and thereby cause sudden death, meaning it is important to treat. ### Aetiology - Torsades de Pointes is basically always associated with a long QT interval. - Therefore, all causes are those which cause a prolonged QT interval. - These include congenital causes, electrolyte disturbances and medications amongst other things (see [[Long QT Syndrome]] for further detail). ### Pathophysiology - It is theorised that Torsades de Pointes originates from inhibition of delayed rectifier potassium current. - This leads to an excess of positive ions which prolong the repolarisation phase (causing a long QT interval). - If an ectopic beat is generated during this prolongation, this can result in Torsades de Pointes. - The management for Torsades de Pointes uses [[Magnesium Sulphate]] as Magnesium Sulphate blocks calcium channels during repolarisation, which surpresses afterdepolarisations that can cause the ectopics leading to Torsades. ### Management If the patient is unstable: - Immediate DC Cardioversion If the patient is stable: 1. [[Magnesium Sulphate]] IV 2g over 10 minutes N.B. [[Beta Blockers]] (other than sotalol) and Atrial/Ventricular Pacing can also be considered. ![[Pasted image 20240612194318.png]] ![[ecg069b.png]] ### Resources Cohagan B, Brandis D. Torsade de Pointes. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459388/ Arrhythmias - NICE BNF https://bnf.nice.org.uk/treatment-summaries/arrhythmias/#ventricular-tachycardia Torsades de pointes - PassMed Tachycardias - Pulsenotes https://app.pulsenotes.com/clinical/ecgs/notes/6-tachycardias