Torsades de Pointes

Arrhythmia

Recognition

  • Polymorphic VT with twisting QRS axis around baseline
  • Preceded by long QT

Key findings

  • Often non-sustained, self-limiting episodes

Clinical importance

  • Risk of degeneration to VF / sudden death

Management pearls

  • Stop QT-prolonging drugs
  • Magnesium 2 g IV over 10 min
  • Correct K⁺ ≥4.5
  • Overdrive pacing or isoprenaline if recurrent
  • DC shock if unstable
WardRound

WardRound

Clinical Decisions in Seconds