TdP

 Q: 47 years old male who is in ICU for severe psychosis went into Torsades De Pointes (TdP) with hemodynamic instability. Which of the following is the first line of treatment? (select one) 

 A) Intravenous (IV) Magnesium (Mg) 

B) Overdrive pacing 

 

Answer: A

 IV Mg continues to be the first line of treatment in TdP. In hemodynamically unstable patients, the dose is 1 to 2 gram IV bolus which can be given up to 4 grams. It can be continued as an infusion. Overdrive pacing can be used at a rate of about 100 beats per minute if IV Mg fails to show any effect. 

Isoproterenol can also be used. Alkalinization of the plasma with sodium bicarbonate is recommended if TdP is due to quinidine. 

Patient in the above question was admitted to ICU with severe psychosis. It is probable that TdP is due to anti-psychotic. Discontinuation of the offending drug is the ultimate treatment.

#cardiology

#hemodynamic

References:

1. Passman R, Kadish A. Polymorphic ventricular tachycardia, long Q-T syndrome, and torsades de pointes. Med Clin North Am 2001; 85:321. 

2. Khan IA. Long QT syndrome: diagnosis and management. Am Heart J 2002; 143:7. 

3. Tzivoni D, Banai S, Schuger C, et al. Treatment of torsade de pointes with magnesium sulfate. Circulation 1988; 77:392.

4. Gowda RM, Khan IA, Wilbur SL, Vasavada BC, Sacchi TJ. Torsade de pointes: the clinical considerations. Int J Cardiol. 2004;96(1):1-6. doi:10.1016/j.ijcard.2003.04.055