Torsades de Pointes Explained in 3 Minutes

Описание: Torsades de Pointes is a polymorphic ventricular tachycardia associated with a prolonged QT interval. It's a medical emergency that can quickly degenerate into ventricular fibrillation and cardiac arrest.

What Causes It?
• Prolonged QTc greater than 500 ms
• Common triggers include:
 – Electrolyte imbalances (low magnesium, potassium, or calcium)
 – Medications (e.g. antiarrhythmics, antipsychotics, macrolide antibiotics)
 – Congenital long QT syndrome
 – Bradycardia or pauses in the cardiac cycle

ECG Characteristics:
• Irregular, twisting QRS complexes
• Amplitude appears to rotate around the isoelectric line
• Often described as a “twisting ribbon” pattern

Treatment Summary:
• Magnesium sulfate 1–2 g IV push, even if levels are normal
• Defibrillation if pulseless
• Overdrive pacing or isoproterenol for recurrent cases
• Stop all QT-prolonging meds
• Correct all electrolyte abnormalities ASAP

Why It Matters:
Torsades can look confusing, but treatment must be fast and specific. Learn to recognize the rhythm, know when to push magnesium, and act before it progresses to VF.

This rhythm kills quickly. Be ready.