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| {{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}} | | {{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}} |
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| | ==[[Torsades de pointes overview|Overview]]== |
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| | ==[[Torsades de pointes historical perspective|Historical Perspective]]== |
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| ===Clinical Correlation === | | ==[[Torsades de pointes pathophysiology|Pathophysiology]]== |
| # Drugs: [[quinidine]], [[PCA]], [[norpace]], [[amiodarone]], [[phenothiazines]], [[Tricyclic antidepressants]], [[pentamidine]].
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| #* with [[quinidine]] majority of the cases occur within one week of initiation, and with therapeutic levels
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| # Electrolyte imbalances: [[Hypokalemia]], [[hypomagnesemia]], [[hypocalcemia]]
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| # [[CAD]]
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| # [[MVP]]
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| # Variant [[angina]]
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| # [[Myocarditis]]
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| # [[Subarachnoid hemorrhage]]
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| # Congenital QT prolongation
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| # Liquid protein diets
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| # [[Hypothyroidism]]
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| #* because of bradycardia and a prolonged QT syndrome
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| # Organophosphate poisoning <ref>Chou's Electrocardiography in Clinical Practice Third Edition, pp. 398-409.</ref> <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194 ISBN 1591032016</ref>
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| ==Other lab studies== | | ==[[Torsades de pointes causes|Causes]]== |
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| * Electrolytes levels to rule out [[hypokalemia]], [[hypomagnesemia]], and [[hypocalcemia]].
| | ==[[Torsades de pointes differential diagnosis|Differentiating Torsades de pointes from other Diseases]]== |
| * [[Cardiac enzymes]]
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| * [[Echocardiography]] to rule out structural heart disease
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| ==Treatment== | | ==[[Torsades de pointes risk factors|Risk Factors]]== |
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| ===Acute Treatment === | | ==[[Torsades de pointes natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| If the episode of does not terminate on its own and degenerates into ventricular fibrillation, [[cardioversion]] is required.
| | ==Diagnosis== |
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| [[Image:Torsades_converted_by_AICD_ECG_strip_Lead_II.JPG|thumb|center|800px|Lead II [[electrocardiogram]] showing [[Torsades]] being shocked by an [[Implantable cardioverter-defibrillator]] back to the patients baseline [[cardiac rhythm]].]] | | [[Torsades de pointes history and symptoms|History and Symptoms]] | [[Torsades de pointes physical examination|Physical Examination]] | [[Torsades de pointes laboratory findings|Laboratory Findings]] | [[Torsades de pointes electrocardiogram|Electrocardiogram]] | [[Torsades de pointes ekg examples|EKG Examples]] | [[Torsades de pointes echocardiography|Echocardiography]] | [[Torsades de pointes other diagnostic studies|Other Diagnostic Studies]] |
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| Once the patient is back in normal sinus rhythm, a vigorous search for and correction of conditions that predispose to torsades de pointes which include [[hypokalemia]], [[hypomagnesemia]], and [[bradycardia]] should be made. [[Magnesium sulfate]] (1-2 g IV over 30-60 seconds) reduces the influx of calcium thereby lowering the amplitude of early after depolarizations and should also be infused even if the magnesium is normal. <ref name="pmid15466950">{{cite journal |author=Hoshino K, Ogawa K, Hishitani T, Isobe T, Eto Y |title=Optimal administration dosage of magnesium sulfate for torsades de pointes in children with long QT syndrome |journal=J Am Coll Nutr |volume=23 |issue=5 |pages=497S–500S |year=2004 |month=October |pmid=15466950 |doi= |url=http://www.jacn.org/cgi/pmidlookup?view=long&pmid=15466950}}</ref><ref name="pmid16635167">{{cite journal |author=Hoshino K, Ogawa K, Hishitani T, Isobe T, Etoh Y |title=Successful uses of magnesium sulfate for torsades de pointes in children with long QT syndrome |journal=Pediatr Int |volume=48 |issue=2 |pages=112–7 |year=2006 |month=April |pmid=16635167 |doi=10.1111/j.1442-200X.2006.02177.x |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1328-8067&date=2006&volume=48&issue=2&spage=112}}</ref>
| | ==Treatment== |
| Administration of [[lidocaine]] is generally not effective, but mexiletene may be helpful in suppressing the recurrence of torsade de pointes.
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| ==Additional Information==
| | [[Torsades de pointes medical therapy|Medical Therapy]] | [[Torsades de pointes primary prevention|Primary Prevention]] | [[Torsades de pointes secondary prevention|Secondary Prevention]] | [[Torsades de pointes cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Torsades de pointes future or investigational therapies|Future or Investigational Therapies]] |
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| *[[Torsade de Pointes and Polymorphic VT]]
| | ==Case Studies== |
| | [[Torsades de pointes case study one|Case #1]] |
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| ==Examples== | | ==Related Chapters== |
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| '''EKG's shown below are courtesy of [[C. Michael Gibson]] MS MD, and copylefted'''
| | *[[Torsade de Pointes and Polymorphic VT]] |
| | | *[[Long QT syndrome]] |
| <gallery perRow="3">
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| image:TdP.1.1.jpg|12 lead EKG at admission
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| image:TdP.1.2.1.jpg
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| image:TdP.1.2.2.jpg
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| image:TdP.1.3.1.jpg
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| image:TdP.1.3.2.jpg
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| image:TdP.1.4.1.jpg
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| image:TdP.1.4.2.jpg
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| image:TdP.1.5.1.jpg
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| image:TdP.1.5.2.jpg
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| image:TdP.1.6.1.jpg
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| image:TdP.1.6.2.jpg
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| image:TdP.1.7.jpg
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| </gallery>
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| '''Examples from different resources'''
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:shortcoupled_tdp1.jpg|Arrhythmias in a patient with short coupled torsade de pointes<ref name="Leenhardt"> Leenhardt A, Glaser E, Burguera M, Nuernberg M, Maison-Blanche P, and Coumel P. Short-coupled variant of torsade de pointes. A new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias. Circulation 1994 Jan; 89(1) 206-15. PMID 8281648 </ref>
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| image:shortcoupled_tdp2.jpg|Arrhythmias in a patient with short coupled torsades de pointes degenerating in [[ventricular fibrillation]]<ref name="Leenhardt"> Leenhardt A, Glaser E, Burguera M, Nuernberg M, Maison-Blanche P, and Coumel P. Short-coupled variant of torsade de pointes. A new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias. Circulation 1994 Jan; 89(1) 206-15. PMID 8281648 </ref>
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:shortcoupled_tdp3.jpg|Arrhythmias in a patient with short coupled torsade de pointes: frequent short coupled extrasystoles<ref name="Leenhardt"> Leenhardt A, Glaser E, Burguera M, Nuernberg M, Maison-Blanche P, and Coumel P. Short-coupled variant of torsade de pointes. A new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias. Circulation 1994 Jan; 89(1) 206-15. PMID 8281648 </ref>
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| image:shortcoupled_tdp4.jpg|Arrhythmias in a patient with short coupled torsade de pointes: frequent short coupled extrasystoles <ref name="Leenhardt"> Leenhardt A, Glaser E, Burguera M, Nuernberg M, Maison-Blanche P, and Coumel P. Short-coupled variant of torsade de pointes. A new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias. Circulation 1994 Jan; 89(1) 206-15. PMID 8281648 </ref>
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| image:12leadTorsade.jpg|A 12 lead ECG recording example of TdP<ref>Khan IA. Twelve-lead electrocardiogram of torsade de pointes Tex Heart Inst J. 2001; 28 (1): 69. PMID 11330748 </ref>
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| </gallery>
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| </div>
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| [[Image:Tosadesdepointes.jpg|center|thumb|300px|Characteristic tracing showing the "twisting" (blue line) of Torsade de pointes]]
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| ==References==
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| {{Reflist|2}}
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| [[de:Torsade de pointes]]
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| [[pl:Torsade de pointes]] | | [[pl:Torsade de pointes]] |
| [[tr:Torsade de pointes]] | | [[tr:Torsade de pointes]] |
