Torsade de Pointes
Rate : 200 - 250 bpm
Rhythm : Irregular
P - Wave : NONE
PR - Interval : NONE
QRS : Wide & more than 0.10 sec
With bizarre appearance
This condition is basically a polymorphic
Ventricular tachycardia characterized by
Wide QRS intervals & long QT intervals
The word Torsades de pointes
is a French term Meaning
twisting of the points
Causes of Torsades de pointes are
Congenital long QT syndromes
Jervell and Lange-Nielsen syndrome
Romano-Ward syndrome
Acquired long QT syndromes
Antiarrhythmic drugs
Class 1A - Quinidine, disopyramide, procainamide
Class III - Sotalol, amiodarone
ibutilide, dofetilide, almokalant
Antibiotics - Erythromycin, clarithromycin
azithromycin, levofloxacin, moxifloxacin
gatifloxacin, trimethoprim-sulfamethoxazole
clindamycin, pentamidine, amantadine, chloroquine
Antifungals - Ketoconazole, itraconazole
Antipsychotics- Haloperidol, phenothiazines
thioridazine, trifluoperazine, sertindole
zimeldine, ziprasidone6 , fluoxetine
Tricyclic and tetracyclic antidepressants
Antihistamines - histamine1-receptor antagonists
Terfenadine, astemizole, diphenhydramine, hydroxyzine
Cholinergic antagonists - Cisapride
organophosphates pesticides
Diuretics - Indapamide
hydrochlorothiazide, furosemide
Antihypertensives - Bepridil, lidoflazine
prenylamine, ketanserin Lithium
Other drugs - Anticonvulsants (phenytoin), oral hypoglycemics
(massive blood transfusions)
vasopressin , carbamazepine cocaine
organophosphorus poisoning
Some drugs (eg, amiodarone) routinely
prolong QT but are less commonly associated
with clinical consequences of long QT
Electrolyte abnormalities - Hypokalemia
hypomagnesemia, hypocalcemia
Endocrine disorders - Hypothyroidism
hyperparathyroidism, pheochromocytoma
hyperaldosteronism
Cardiac conditions -Myocardial ischemia
myocardial infarction
myocarditis, bradyarrhythmia, complete
atrioventricular (AV) block
takotsubo cardiomyopathy
Intracranial disorders - Subarachnoid hemorrhage
thalamic hematoma, cerebrovascular accident
encephalitis, head injury
Nutritional disorders - Anorexia nervosa
starvation, liquid protein diets
gastroplasty and ileojejunal
bypass, celiac disease
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