Torsade de Pointes


Article Author:
Brian Cohagan


Article Editor:
Dov Brandis


Editors In Chief:
Kranthi Sitammagari
Mayank Singhal


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Kyle Blair
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Daniyal Ameen
Altif Muneeb
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes
Komal Shaheen
Sandeep Sekhon


Updated:
2/17/2019 9:19:08 AM

Introduction

Torsades de Pointes is a type of polymorphic ventricular tachycardia characterized by a gradual change in amplitude and twisting of the QRS complexes around an isoelectric line on the electrocardiogram. Torsades de Pointes is associated with QTc prolongation, which is the heart rate adjusted lengthening of the QT interval. A QTc is considered long when it is greater than 450 ms in males and 460 ms in females. A QTc greater than 500 ms has been associated with a two-fold to three-fold increase in risk for Torsades de Pointes. The rhythm may terminate spontaneously or may degenerate into ventricular fibrillation.[1][2][3]

Etiology

Torsades de pointes is the result of QTc prolongation which can either be congenital or acquired. Acquired QTc prolongation is most often drug-related. There is an extensive list of medications that can predispose a person to torsades. The list includes but is not limited to: antiarrhythmics, antipsychotics, antiemetics, antifungals, and antimicrobials. Substances that slow the hepatic metabolism of these medications can potentiate QTc prolongation leading to an increased likelihood of torsades de pointes. Congenital prolonged QT has two genetic variants: Jervell and Lange-Nielsen and Romano-Ward syndrome. The former is associated with congenital deafness. Prolonged QTc and Torsades are also associated with certain risk factors that include: older age (older than 65), female gender, hypokalemia, hypocalcemia, hypomagnesemia, bradycardia, heart disease, and diuretic use.[4][5]

Two rare congenital long QT syndromes include Romano-Ward syndrome and Jervell and Lange Nielsen syndrome.

Epidemiology

The prevalence of congenital prolonged QT is largely unknown. Figures estimate between 1:2000 and 1:20,000 have the genetic mutation for QT prolongation. Clinically more males than females exhibit the trait. Little is also known about the prevalence or incidence of drug-induced torsades de pointes. This is mainly because the arrhythmia is often transient, and an accurate diagnosis requires an ECG to be recorded during the event. Several European centers estimate that the annual reporting rate of drug-induced Torsades de Pointes is between 0.8 and 1.2 per million person-years. The incidence of drug-induced Torsades de Pointes also varies based on the drug in question and the population being studied.[6][7][8]

Pathophysiology

The proposed mechanism for Torsades de Pointes involves inhibition of the delayed rectifier potassium current. This leads to an excess of positive ions within the cellular membrane causing a prolonged repolarization phase. If an ectopic beat is generated during this prolonged repolarization phase, known as an R on T phenomenon, this can result in Torsades de Pointes. Both congenital and drug-induced QT prolongation affect the cellular membrane in similar fashions by blocking the potassium channel. Torsades de Pointes is slightly different from ventricular fibrillation in that it can spontaneously resolve. However, Torsades de Pointes can ultimately progress into venticular fibrillation if left untreated.[9]

History and Physical

Around 50% of patients with Torsades de Pointes are asymptomatic. The most common symptoms reported are syncope, palpitations, and dizziness. However, cardiac death is the presenting symptom in up to 10% of patients.

Patients with Jervell and Lange Nielsen syndrome may have a history of deafness.

Today one needs to be aware that drug-induced long QT syndrome is common and hence, a thorough medication history must be obtained.

Patients with torsade may be hypotensive, have a rapid pulse and have loss of consciousness.

Evaluation

An electrocardiogram is paramount in the diagnosis of Torsades de Pointes. The characteristic finding is a twisting of the QRS complexes around an isoelectric line. Torsades de Pointes is triggered by a PVC occurring on a preceding T wave. The onset of Torsades de Pointes is often preceded by a run of short-long-short R-R intervals. A QT nomogram can provide a sensitive and specific assessment of the risk of Torsades de Pointes in drug-induced QTc prolongation. Any value plotted above the line on the nomogram puts the patient at risk of Torsades de Pointes.[10][11]

Treatment / Management

The first step in managing Torsades de Pointes is preventing its onset by targeting modifiable risk factors. This includes discontinuing any QT prolonging drugs and optimizing a patient’s electrolyte profile. Correcting hypokalemia, hypomagnesemia, and hypocalcemia can all help to prevent the onset of torsades. There are a small number of studies that show a possible prophylactic benefit of oral or IV magnesium for those patients with drug-induced prolonged QT. However, the overall benefit is not well established, and there is little evidence that magnesium has any effect on the actual QT interval. The management of Torsades de Pointes begins with assessing if the patient is hemodynamically stable. Most episodes of torsades are self-limiting. However, the danger lies in those patients who go on to develop ventricular fibrillation. For those patients with hypotension or in cardiac arrest from Torsades de Pointes, electrical cardioversion should be performed. Synchronized cardioversion should be performed on a hemodynamically unstable patient in torsades who has a pulse, (100J monophasic, 50J Biphasic). Pulseless torsades should be defibrillated. Intravenous magnesium is the first-line pharmacologic therapy in Torsades de Pointes. Magnesium has been shown to stabilize the cardiac membrane, though the exact mechanism is unknown. 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. Severe magnesium toxicity is seen with levels greater than 3.5 mmol/L and can present as confusion, respiratory depression, coma, and cardiac arrest. It is important to remember to correct any hypokalemia as well. Serum potassium should be maintained between 4.5 mmol/L and 5 mmol/L when treating Torsades de Pointes.

For a patient that continues to have intermittent runs of Torsades de Pointes, despite treatment with magnesium, increasing the heart rate may also help. This can be done pharmacologically with medications such as isoproterenol. Isoproterenol has been shown to help prevent Torsades de Pointes in patients with prolonged QT that is refractory to magnesium. It is a non-selective beta agonist, which increases the heart rate and shortens the QT interval. This lowers the likelihood of an R-on-T phenomenon that can lead to TdP. Isoproterenol can be given as an IV push of 10 mcg to 20mcg or an infusion titrated to maintain a heart rate of 100 bpm. Isoproterenol is, however, contraindicated in patients with congenital prolonged QT, because it can paradoxically lengthen the QT interval. A final option for terminating torsades is overdrive pacing. There are limited studies on the success of pacing for treatment of Torsades de Pointes; however, there are numerous case reports that show it is a viable option. Overdrive pacing can be used in the setting of both frequent runs of torsades and Torsades de Pointes that is refractory to magnesium. The rate must be set to overcome the patient’s intrinsic rate of ectopy. Ventricular rates of 90 bpm to 110 bpm are usually sufficient to overcome the arrhythmia, however occasionally rates up to 140 bpm have been required for some patients. Overdrive pacing is recommended for both drug and chemical induced Torsades de Pointes.[12][7][13]

Differential Diagnosis

  • Ventricular tachycardia/fibrillation
  • Dialysis-related complications
  • Syncope
  • Drug toxicity- antihistamines, antiarrhythmics

Complications

  • Ventricular fibrillation
  • Sudden cardiac death

Consultations

  • Electrophysiologist
  • Cardiologist
  • Geneticist if the patient has congenital long QT syndrome

Enhancing Healthcare Team Outcomes

Torsade is a rare arrhythmia, but it can quickly be fatal if not diagnosed and treated. Patients may present with a range of symptoms but it is the ECG that is diagnostic. While the arrhythmia is managed by physicians, all nurses should recognize this arrhythmia and consult with the cardiologist. Those who have a congenital disorder causing prolonged QT interval should be told to refrain from exercise. The pharmacist should educate the patient on medication compliance to prevent recurrence. Close follow up is required because the risk of sudden death is present. The pharmacist must be aware of all drugs the patient is taking and ensure that he or she is not on any medications that prolonged the QT interval. Finally, the nurse should teach all patients how to monitor their pulses and note for the presence of any adverse effects from the medications. In addition, the family should be taught basic life support. [14][15][16](Level V) 

Outcomes

For patients with congenital long QT syndromes, the mortality for untreated patients is more than 50% over 5 years. With intervention, the mortality rates can be decreased to single digits. In patients with acquired long QT syndrome, the prognosis is good as long as the trigger medication or factor has been identified and discontinued. [17][18](Level V)


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Torsade de Pointes - Questions

Take a quiz of the questions on this article.

Take Quiz
Which of the following factors predisposes a patient to the development of torsade de pointes?

(Move Mouse on Image to Enlarge)
  • Image 6170 Not availableImage 6170 Not available
    Image courtesy S Bhimji MD
Attributed To: Image courtesy S Bhimji MD



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is least likely to cause torsades de pointes?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Torsades de pointes is associated with the use of which of the following?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not a cause of torsades de pointes?

(Move Mouse on Image to Enlarge)
  • Image 3900 Not availableImage 3900 Not available
    Contributed by Tammy J. Toney-Butler, AS, RN, CEN, TCRN, CPEN
Attributed To: Contributed by Tammy J. Toney-Butler, AS, RN, CEN, TCRN, CPEN



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the term for the arrhythmia shown in the image below?

(Move Mouse on Image to Enlarge)
  • Image 4866 Not availableImage 4866 Not available
    Contributed by Wikimedia Commons, Panthro (Public Domain-Self)
Attributed To: Contributed by Wikimedia Commons, Panthro (Public Domain-Self)



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the treatment for an unstable patient with torsades de pointes?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following has no effect on torsades de pointes?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
For long-term control of torsades, which class of drugs is often used?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not a risk factor for torsade de pointes?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the first line of therapy for torsade de pointes in the setting of stable blood pressure, normal pulse rate, and normal serum electrolytes?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which nutritional disorder is often associated with torsade de pointes?

(Move Mouse on Image to Enlarge)
  • Image 4866 Not availableImage 4866 Not available
    Contributed by Wikimedia Commons, Panthro (Public Domain-Self)
Attributed To: Contributed by Wikimedia Commons, Panthro (Public Domain-Self)



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following drugs does not cause torsades de pointes?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following medications is least likely to cause torsades de pointes?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient develops torsades de pointes secondary to haloperidol. Cardioversion is required. What is the best next step in management?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the treatment of choice for emergent torsade de pointes?

(Move Mouse on Image to Enlarge)
  • Image 3900 Not availableImage 3900 Not available
    Contributed by Tammy J. Toney-Butler, AS, RN, CEN, TCRN, CPEN
Attributed To: Contributed by Tammy J. Toney-Butler, AS, RN, CEN, TCRN, CPEN



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not used to treat torsade de pointes?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A young female with a history of allergies has been on loratadine for a long time. She tolerated the medication quite well, but upon returning from a vacation, she developed a wet cough, low-grade fever, and general malaise. Her clinician prescribed her an antibiotic. A few days later she presented to the emergency department with nausea, cold sweats, diaphoresis and marked shortness of breath. Vital signs revealed a BP of 90/45 and a rapid, weak pulse. A quick ECG revealed prolonged QT-interval with pauses, U waves and a progressive change in polarity of QRS about the isoelectric line. Her heart rate varies from 45-60 beats per minute, and her blood pressure is 95/65 mmHg. The patient is sent to the ICU, and all her medications are discontinued. Blood work is sent. In the meantime, which medication would be of benefit to this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not a risk factor for torsades?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What medication can be used for the treatment of torsades that is refractory to magnesium?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 65-year-old female is in the emergency department with vague abdominal pain and nausea, which has been going on for a few days. She has a long and complex medical history which includes diabetes mellitus, hypertension, gout, arthritis, ischemic heart disease, prior transient ischemic attacks, and several remote surgeries. She is on furosemide, allopurinol, ibuprofen, vitamin complex, metformin, enalapril, albuterol, and aspirin. Her vitals include a blood pressure of 160/85 mmHg, pulse 110 beats/min, respiratory rate 20/minute, and temperature 100 F. The physical exam is unremarkable, but the provider is unable to make any medical decision without the laboratory results. While waiting for the laboratory results to return, the patient suddenly becomes unresponsive, and a pulse cannot be palpated. The ECG shows the below rhythm. What is the Bazett formula used to calculate the QTc interval?

(Move Mouse on Image to Enlarge)
  • Image 5983 Not availableImage 5983 Not available
    Contributed by S bhimji MD
Attributed To: Contributed by S bhimji MD



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
On the cardiology floor, you note that the patient has the following rhythm. Which electrolyte disturbance is known to precipitate such an arrhythmia? Select all that apply.

(Move Mouse on Image to Enlarge)
  • Image 6170 Not availableImage 6170 Not available
    Image courtesy S Bhimji MD
Attributed To: Image courtesy S Bhimji MD



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which endocrine disorder is a risk factor for the arrhythmia shown in the image? Select all that apply.

(Move Mouse on Image to Enlarge)
  • Image 5983 Not availableImage 5983 Not available
    Contributed by S bhimji MD
Attributed To: Contributed by S bhimji MD



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 73-year old female is admitted to the hospital for elective cholecystectomy. Her medical history is significant for uncontrolled hypertension, type 2 diabetes mellitus, gout, chronic renal dysfunction, transient ischemic attack in the past, and persistent asthma. During preoperative evaluation, she appears anxious and tachypneic. After the administration of lorazepam, she suddenly becomes unresponsive. Her blood pressure is recorded as 70/30 mmHg, with a faintly palpable irregular pulse. Her temperature is 98.5-degree Fahrenheit. She subsequently has no palpable pulse. The bedside cardiac monitor reveals the rhythm shown in the image. What is the next step in her management?

(Move Mouse on Image to Enlarge)
  • Image 6913 Not availableImage 6913 Not available
    Image courtesy S Bhimji MD
Attributed To: Image courtesy S Bhimji MD



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 55-year-old male with a long history of alcohol abuse presents with generalized weakness and fatigue. His last drink was 5 hours ago. Vitals signs are: BPL 86/54, pulse: 110, respiratory rate: 26, temperature: 103F. Physical examination reveals dry oral mucosa and tachypnea, but no use of accessory respiratory muscles. On auscultation of the chest, he has crackles in the right lower lobes. Laboratory examination shows an elevated WBC count, and kidney function tests show an elevated creatinine and BUN. ECG shows sinus tachycardia. Chest X-ray shows right lower lobe pneumonia. For his low blood pressure, he receives a bolus of 2 liters of Ringer's lactate and is admitted to the telemetry floor with a diagnosis of aspiration pneumonia. Appropriate cultures are drawn, and he is started on proper antibiotics and Ringer's lactate at 150 mL/hour. After 8 hours rapid response is called as he is very agitated and restless. He is diagnosed with delirium tremens (DTs) and receives 2 mg of lorazepam with no improvement. He is moved to medical ICU, and 1 hour later he is sedated and intubated due to extreme agitation and restlessness. By the second day, his blood pressure and white count improve but he is still agitated and is kept on sedatives. He is reseated and started on tube feeds. Sedative medications are stopped on the third day. Later that day, the patient's telemetry monitor shows an abnormal pattern. BP is 100/55, phosphate: 2.2mEq/L (normal 2.5-4 mEq/L) and potassium is 3.2mEq/L (normal 3.5-5mEq/L). His ECG is shown in the figure. What is the next step in the management of this patient?

(Move Mouse on Image to Enlarge)
  • Image 9849 Not availableImage 9849 Not available
    Contirbuted by Wikimedia User: Jer5150 (CC by SA 3.0 https://creativecommons.org/licenses/by-sa/3.0/deed.en)
Attributed To: Contirbuted by Wikimedia User: Jer5150 (CC by SA 3.0 https://creativecommons.org/licenses/by-sa/3.0/deed.en)



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Torsade de Pointes - References

References

Van Laecke S, Hypomagnesemia and hypermagnesemia. Acta clinica Belgica. 2018 Sep 17     [PubMed]
Wilders R,Verkerk AO, Long QT Syndrome and Sinus Bradycardia-A Mini Review. Frontiers in cardiovascular medicine. 2018     [PubMed]
Khan Q,Ismail M,Haider I, High prevalence of the risk factors for QT interval prolongation and associated drug-drug interactions in coronary care units. Postgraduate medicine. 2018 Sep 5     [PubMed]
De Vecchis R,Ariano C,Di Biase G,Noutsias M, Acquired drug-induced long QTc: new insights coming from a retrospective study. European journal of clinical pharmacology. 2018 Aug 15     [PubMed]
Salem JE,Dureau P,Bachelot A,Germain M,Voiriot P,Lebourgeois B,Trégouët DA,Hulot JS,Funck-Brentano C, Association of Oral Contraceptives With Drug-Induced QT Interval Prolongation in Healthy Nonmenopausal Women. JAMA cardiology. 2018 Aug 1     [PubMed]
Salem M,Reichlin T,Fasel D,Leuppi-Taegtmeyer A, Torsade de pointes and systemic azole antifungal agents: Analysis of global spontaneous safety reports. Global cardiology science     [PubMed]
Porta-Sánchez A,Gilbert C,Spears D,Amir E,Chan J,Nanthakumar K,Thavendiranathan P, Incidence, Diagnosis, and Management of QT Prolongation Induced by Cancer Therapies: A Systematic Review. Journal of the American Heart Association. 2017 Dec 7     [PubMed]
Heemskerk CPM,Pereboom M,van Stralen K,Berger FA,van den Bemt PMLA,Kuijper AFM,van der Hoeven RTM,Mantel-Teeuwisse AK,Becker ML, Risk factors for QTc interval prolongation. European journal of clinical pharmacology. 2018 Feb     [PubMed]
Baldzizhar A,Manuylova E,Marchenko R,Kryvalap Y,Carey MG, Ventricular Tachycardias: Characteristics and Management. Critical care nursing clinics of North America. 2016 Sep     [PubMed]
Alders M,Bikker H,Christiaans I, Long QT Syndrome null. 1993     [PubMed]
Turner JR,Rodriguez I,Mantovani E,Gintant G,Kowey PR,Klotzbaugh RJ,Prasad K,Sager PT,Stockbridge N,Strnadova C, Drug-induced Proarrhythmia and Torsade de Pointes: A Primer for Students and Practitioners of Medicine and Pharmacy. Journal of clinical pharmacology. 2018 Apr 19     [PubMed]
de Lemos ML,Kung C,Kletas V,Badry N,Kang I, Approach to initiating QT-prolonging oncology drugs in the ambulatory setting. Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners. 2018 Jan 1     [PubMed]
Al-Khatib SM,Stevenson WG,Ackerman MJ,Gillis AM,Bryant WJ,Hlatky MA,Callans DJ,Granger CB,Curtis AB,Hammill SC,Deal BJ,Joglar JA,Dickfeld T,Kay GN,Field ME,Matlock DD,Fonarow GC,Myerburg RJ,Page RL, 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart rhythm. 2017 Oct 30     [PubMed]
Crimmins S,Vashit S,Doyle L,Harman C,Turan O,Turan S, A multidisciplinary approach to prenatal treatment of congenital long QT syndrome. Journal of clinical ultrasound : JCU. 2017 Mar 4     [PubMed]
Shulman M,Miller A,Misher J,Tentler A, Managing cardiovascular disease risk in patients treated with antipsychotics: a multidisciplinary approach. Journal of multidisciplinary healthcare. 2014     [PubMed]
van Aerde KJ,Kalverdijk LJ,Reimer AG,Widdershoven JA, [QT interval prolongation and psychotropic drugs in children and adolescents: proposed guideline]. Nederlands tijdschrift voor geneeskunde. 2008 Aug 9     [PubMed]
Tse G,Gong M,Meng L,Wong CW,Bazoukis G,Chan MTV,Wong MCS,Letsas KP,Baranchuk A,Yan GX,Liu T,Wu WKK, Predictive Value of T {sub}{b}peak{/b}{/sub} - T {sub}{b}end{/b}{/sub} Indices for Adverse Outcomes in Acquired QT Prolongation: A Meta-Analysis. Frontiers in physiology. 2018     [PubMed]
Ramalho D,Freitas J, Drug-induced life-threatening arrhythmias and sudden cardiac death: A clinical perspective of long QT, short QT and Brugada syndromes. Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology. 2018 May     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of PA-Hospital Medicine. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for PA-Hospital Medicine, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in PA-Hospital Medicine, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of PA-Hospital Medicine. When it is time for the PA-Hospital Medicine board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study PA-Hospital Medicine.