Torsades de Pointes

Means the twisting of the points, a polymorphic ventricular tachycardia characterized by periods of increasing QRS amplitude followed with a period of reduced QRS amplitude – then the pattern repeats again; often associated with effects of cardiac drugs or with low magnesium blood levels; often preceded by long QT intervals.

Associated with long QT syndrome and any drugs that prolong the QT interval (quinidine, procainamide), Torsades de Pointes (TdP) is a polymorphic – many shapes – ventricular tachycardia. It can be differentiated from ventricular fibrillation in that TdP has an undulating pattern of increasing and decreasing amplitude. Ventricular fibrillation is chaotic, devoid of any pattern.

Torsades de Pointes is often associated with hemodynamic compromise. Notice in the prolonged QT interval present prior to the episode of TdP. Treatment includes discontinuing medications that may prolong the QT interval, administering magnesium, and overdrive pacing.

torsades des pointes

1. Six Second ECG Guidebook (2012), T Barill, p. 122, 207

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