Question: What Is The Drug Of Choice For Torsades De Pointes?

Why is magnesium given for torsades?

Magnesium is the drug of choice for suppressing early afterdepolarizations (EADs) and terminating the arrhythmia.

Magnesium achieves this by decreasing the influx of calcium, thus lowering the amplitude of EADs.

Magnesium can be given at 1-2 g IV initially in 30-60 seconds, which then can be repeated in 5-15 minutes..

Is torsades VT or VF?

Frequent PVCs with ‘R on T’ phenomenon trigger a run of polymorphic VT which subsequently begins to degenerate to VF. QT is difficult to see because of artefact but appears slightly prolonged (QTc ~480ms), making this likely to be TdP.

What medications prolong QTc?

Table 2 Some drugs associated with QTc prolongationAntibiotics. azithromycin. clarithromycin. erythromycin. roxithromycin. metronidazole. (with alcohol) moxifloxan.Antifungals. fluconazole. (in cirrhosis) ketoconazole.Antivirals. nelfinavir.Antimalarials. chloroquine. mefloquine.

What drugs can cause Torsades de Pointes?

DRUGS THAT CAUSE QT PROLONGATION AND/OR TORSADES DE POINTESAntiarrhythmics. … Antihistamines. … Antimicrobials. … Tricyclic antidepressants. … Neuroleptics. … Prokinetics. … Other QT prolonging drugs that have been withdrawn.

What happens in Torsades de Pointes?

In the case of torsades de pointes (TdP), the heart’s two lower chambers, called the ventricles, beat faster than and out of sync with the upper chambers, called the atria. An abnormal heart rhythm is called an arrhythmia. When the heart beats much faster than normal, the condition is called tachycardia.

How can you tell Torsades de Pointes?

Symptoms of torsades de pointes include:heart palpitations.dizziness.nausea.cold sweats.chest pain.shortness of breath.rapid pulse.low blood pressure.

Does a pacemaker prevent torsades?

The pacemaker component of such devices should in theory help prevent torsades by preventing bradycardia. However, the rate of most pacemakers is not likely to provide protection from torsades.

Why pea is not shockable?

In PEA, there is electrical activity, but the heart either does not contract or there are other reasons this results in an insufficient cardiac output to generate a pulse and supply blood to the organs.

Why do doctors give magnesium?

Magnesium gluconate is used to treat low blood magnesium. Low blood magnesium is caused by gastrointestinal disorders, prolonged vomiting or diarrhea, kidney disease, or certain other conditions. Certain drugs lower magnesium levels as well.

What medications should be avoided with long QT syndrome?

Table 1Drugs to be avoided in patients with c-long QT syndromeAnti-depressantMirtazapine, Citalopram, Venlafaxine, Paroxetine, Fluoxetine, Sertraline, Trazodone, Escitalopram, Clomipramine, Amitriptyline, Imipramine, Nortriptyline, Desipramine, Doxepin, Trimipramine, Protriptyline48 more rows•Apr 26, 2013

Do you defibrillate torsades?

Torsades de pointes is a ventricular tachycardia. In the unstable patient, cardiovert. In the pulseless, defibrillate. (The polymorphic nature of the rhythm may interfere with the defibrillator’s ability to synchronize, so cardioversion may not be possible.

What is the treatment for torsades de pointes?

Pulseless torsades should be defibrillated. Intravenous magnesium is the first-line pharmacologic therapy in Torsades de Pointes. Magnesium has been shown to stabilize the cardiac membrane, though the exact mechanism is unknown. The recommended initial dose of magnesium is a slow 2 g IV push.

Is polymorphic VT the same as torsades?

Polymorphic VT is defined as an unstable rhythm with a continuously varying QRS complex morphology in any recorded ECG lead. Polymorphic VT that occurs in the setting of QT prolongation is considered as a distinct arrhythmia, known as torsades de pointes.

Does magnesium shorten QT interval?

Magnesium sulfate reduced the risk of an ibutilide- induced QTc interval increase of greater than 30 msec or greater than 60 msec and reduced the risk of a QTc interval value of more than 500 msec by 65%, 60%, and 68%, respectively (p=0.07, p=0.175, and p=0.160). Conclusions.

What are the 3 shockable rhythms?

Shockable Rhythms: Ventricular Tachycardia, Ventricular Fibrillation, Supraventricular Tachycardia.

What are the signs of low magnesium in the body?

As magnesium deficiency worsens, symptoms may include:numbness.tingling.muscle cramps.seizures.muscle spasticity.personality changes.abnormal heart rhythms.

What are the causes of torsades?

Common causes for torsades de pointes include drug-induced QT prolongation and less often diarrhea, low serum magnesium, and low serum potassium or congenital long QT syndrome. It can be seen in malnourished individuals and chronic alcoholics, due to a deficiency in potassium and/or magnesium.

Where does torsades de pointes originate?

Conclusion The most frequent site of origin of TdP is the outflow tract. Further studies are needed to understand why this relatively small area of the ventricle is a predominant site of origin of diverse ventricular arrhythmias.