What is the treatment for torsades?

What is the treatment for torsades?

The torsades rhythm is treated with magnesium sulfate 2 g IV over 1 to 2 minutes, correction of hypokalemia, pacing or isoproterenol to increase heart rate, and correction of the cause.

Do you do CPR for torsades?

If torsades de pointes is present, then give magnesium 1-2 g diluted in 10 mL D5W IV/IO push, typically over 5-20 minutes (Class IIa for torsades). Continue CPR followed by 1 shock and additional CPR/medications for 5 cycles or 2 minutes.

Do you pace torsades?

Based on the fact that the QT interval shortens with a faster heart rate, pacing can be effective in terminating torsade. It is effective in both forms of the long QT syndrome because it facilitates the repolarizing potassium currents and prevents long pauses, suppressing EADs and decreasing the QT interval.

Why is magnesium used 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.

Can you be awake with torsades?

In more serious cases, torsades de pointes can cause lack of consciousness, known as syncope, or even a cardiac arrest, which can lead to death.

Which drug is associated with torsades de pointes?

Antiarrhythmic drugs associated with torsade include the following: Class IA – Quinidine, disopyramide, procainamide. Class III – Sotalol, amiodarone (rare), ibutilide, dofetilide, almokalant.

Is torsades VT or VF?

A: Torsades de pointes is a ventricular tachycardia, meaning that it is a fast heartbeat with the electrical activity from the ventricles. The ventricles are the two lower chambers of the heart that pump blood first from the right side of the heart to the lungs, and then from the left side out to the rest of the body.

Do you give atropine for torsades de pointes?

Treatment of torsade de pointes includes: isoproterenol infusion, cardiac pacing, and intravenous atropine. Intravenous magnesium sulfate, a relatively new mode of therapy for torsade de pointes, was proven to be extremely effective and is now regarded as the treatment of choice for this arrhythmia.

How much mag do I need for torsades de pointes?

The recommended initial dose of magnesium is a slow 2 g IV push. An infusion of 1 gm to 4 gm/hr should be started to keep the magnesium levels greater than 2 mmol/L. Once the magnesium level is greater than 3 mmol/L, the infusion can be stopped.

Is torsades a lethal rhythm?

Most cases of torsades de pointes resolve on their own without treatment. However, it can develop into ventricular fibrillation, which can lead to cardiac arrest and may even be fatal.

How rare is torsades de pointes?

Epidemiology of Torsade The prevalence of torsade de pointes is unknown. Torsade is a life-threatening arrhythmia and may present as sudden cardiac death in patients with structurally normal hearts. In the United States, 300,000 sudden cardiac deaths occur per year. Torsade probably accounts for fewer than 5%.

What is another name for torsades de pointes?

When the heart beats faster than usual, as in a case of torsades de pointes, it is called tachycardia. Torsades de pointes is French for “twisting of points” and refers to when the heart’s two lower chambers or ventricles, beat faster than the upper chambers, which are known as the atria.

What are the treatment options for torsade de pointes?

Predisposing factors known to increase the likelihood of developing torsade de pointes are: electrolyte imbalance (hypokalemia, hypomagnesemia, or both) and slow heart rate induced either by sinus bradycardia or heart block. Treatment of torsade de pointes is aimed at shortening the QT interval.

What kind of care do I need for a torsade?

Prehospital Care: EMS should institute immediate ACLS protocol for ventricular tachycardia. Emergency Department Care: Torsade is an inherently unstable rhythm. As such, it is prone to revert to more stable rhythms spontaneously and also to recurrences.

Can a torsades de pointes be a pulseless shock?

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. In that case, in the unstable patient, deliver an unsynchronized shock.) 1

What kind of electrolytes are used for torsades de pointes?

Some of the electrolyte abnormalities associated with torsades de pointes include hypokalemia, and hypomagnesemia. Electrolytes also reduce the arrhythmic effects of offending drugs. Drug Name Magnesium Sulfate – It is the DOC for the treatment of torsade de pointes, known or suspected hypomagnesemia, or severe refractory VF.