Torsades de Pointes (TdP)

Torsades de Pointes (TdP)

David Ray Velez, MD

A Type of Polymorphic Ventricular Tachycardia (PVT) with QT Prolongation

EKG Pattern

  • Polymorphic Ventricular Tachycardia
  • QRS Complexes Appear to Be “Twisting’ Around the Isoelectric Points

Torsades de Pointes (TdP)

Pathophysiology

  • Associated with Prolonged QT Intervals
  • May Be Heralded by Bigeminy with Known Prolonged QT or Abnormally Large T-U Waves
  • Can Occur When a PVC Begins on a Preceding T Wave (“R on T” Phenomenon)
  • Can Convert to Ventricular Fibrillation and Cause Hemodynamic Instability

Treatment

  • Primarily treated with IV Magnesium
  • MgSO4 Bolus 2 g, Then Infuse 2-4 mg/min