torsade de pointes VT
- torsade is an inherently unstable rhythm and will either revert or degenerate to VF, thus commence Rx as soon as it is recognised.
- Most (75-82%) torsade de pointes (TDP) rhythms are started by a pause. Pacing at rates up to 140 bpm may prevent the ventricular pauses that allow TDP to originate.
- often associated with prolonged QTc on ECG which may be hereditary, drug-induced, or have other causes.
- a rare cause is Brugada syndrome which if untreated may be fatal within 2 years.
Mx of torsade de pointes VT:
- oxygen, cardiac monitor, IV access, move to full resuscitative facilities and procedures as for VT
- if in extremis, then DC reversion ASAP
- treat hypokalaemia if present
- stop all drugs which prolong QTc
- iv magnesium sulphate 2-4g initially
- usually very effective even in patients with normal Mg levels
- if fails, repeat dose but watch for Mg toxicity including impaired NM function
- overdrive pacing to HR of 140
- iv isoprenaline (isoproterenol) infusion to maintain HR of 90-100bpm to prevent recurrence
c_torsadevt.txt · Last modified: 2014/08/27 11:04 by 127.0.0.1