Torsades de pointes risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Risk Factors

Factors that are associated with an increased tendency toward torsades de pointes include:

• Familial long QT syndrome
• Class IA antiarrhythmics
• Hypomagnesemia
• Hypokalemia
• Hypoxia
• Acidosis
• Heart failure
• Left ventricular hypertrophy
• Slow heart rate
• Female gender
• Baseline electrocardiographic abnormalities
• Renal or liver failure

Clinical Correlation

1. Drugs: quinidine, PCA, norpace, amiodarone, phenothiazines, Tricyclic antidepressants, pentamidine.
   • with quinidine majority of the cases occur within one week of initiation, and with therapeutic levels
2. Electrolyte imbalances: Hypokalemia, hypomagnesemia, hypocalcemia
3. CAD
4. MVP
5. Variant angina
6. Myocarditis
7. Subarachnoid hemorrhage
8. Congenital QT prolongation
9. Liquid protein diets
10. Hypothyroidism
    • because of bradycardia and a prolonged QT syndrome
11. Organophosphate poisoning