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Torsade de Pointes: Difference between revisions
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Torsade de | '''Torsade de Pointes (TdP)''' is a form of polymorphic ventricular tachycardia associated with a [[Conduction#The_QT_time|long QT interval]] on the resting ECG. Torsade de Pointes is typically initiated by a short-long-short interval. A ventricle extrasystole (first beat: short) is followed by a compensatory pause. The following beat (second beat: long) has a longer QT interval. If the next beat follows shortly thereafter, ther is a good chance that this third beat falls within the QT interval, resulting in the R on T phenomenon and subsequent Torsades de Pointes. During Torsades de Pointes the ventricles depolarize in a circular fashion resulting in QRS complexes with a continuously turning heart axis around the baseline (hence the name ''Torsade de Pointes''). Read the chapter on the [[Long_QT_syndrome|Long QT Syndrome]] for an list of causes. Also, a more rare form of [[short coupled Torsades de Pointes]] has been observed.<cite>Leenhardt</cite> | ||
'''Treatment'''<cite>ACC</cite> | '''Treatment'''<cite>ACC</cite> | ||
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* Isoproterenol as temporary treatment in patients with recurrent pause-dependent TdP who do not have congenital long QT syndrome. | * Isoproterenol as temporary treatment in patients with recurrent pause-dependent TdP who do not have congenital long QT syndrome. | ||
There has been much debate in the ''Circulation'' journal among French and American scientist whether one should write ''Torsades de Pointes'' or ''Torsade de Pointes''. As for now ''Torsade'' is prefered (unless one sees rotations around more than one axis in one episode), but both forms are used in similar frequency.<cite>Moise</cite> | There has been much debate in the ''Circulation'' journal among French and American scientist whether one should '''write ''Torsades de Pointes'' or ''Torsade de Pointes'''''. As for now ''Torsade'' is prefered (unless one sees rotations around more than one axis in one episode), but both forms are used in similar frequency.<cite>Moise</cite> | ||
{{clr}} | {{clr}} | ||
==Examples== | ==Examples== | ||
<gallery> | <gallery> | ||
Image:12leadTorsade.jpg|A twelve lead registration of Torsade de pointes. Reprinted with permission ''Copyright 2001 Texas Heart Institute'' <cite>Khan</cite> | Image:12leadTorsade.jpg|A twelve lead registration of Torsade de pointes. Reprinted with permission ''Copyright 2001 Texas Heart Institute'' <cite>Khan</cite> | ||
File:Torsades_de_Pointes_TdP.png|12-lead ECG of Torsades de Pointes (TdP) in a 56-year-old white female with a potassium of 2.4 mmol/L and a magnesium of 1.6 mg/dL. | |||
</gallery> | </gallery> | ||
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#Eldar pmid=3624666 | #Eldar pmid=3624666 | ||
#ACC pmid=16923744 | #ACC pmid=16923744 | ||
#Leenhardt pmid=8281648 | |||
</biblio> | </biblio> | ||
==External Links== | ==External Links== | ||
*[http://www.torsades.org A long list of drugs that can induce Torsade de Pointes] | |||