Torsade De Pointes, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

By Kenneth Kee

This book describes Torsade de pointes, Diagnosis and Treatment and Related Diseases
Torsades de pointes is a distinctive polymorphic ventricular tachycardia in which the QRS amplitude differs and the QRS complexes seem to twist around the baseline.
Torsades de pointes (French for “twisting of the points”) is linked with a prolonged QT interval, which may be congenital or acquired
Torsades de pointes is normally not sustained and ceases spontaneously but often returns unless the underlying cause is treated.
Torsades de pointes may deteriorate into sustained ventricular tachycardia or ventricular fibrillation.
Torsades is a life-threatening arrhythmia and may manifest as sudden cardiac death in patients with structurally normal hearts.
Risk factors
1. Congenital long QT syndromes such as:
a. Jervell and Lange-Nielsen syndrome,
b. Romano-Ward syndrome.
2. Acquired long QT syndromes:
3. Acute myocardial infarction.
4. Drugs such as:
a. Anti-arrhythmic agents of classes Ia and III,
b. Erythromycin,
c. Ketoconazole,
d. Tricyclic antidepressants,
e. Methadone,
f. Antipsychotics
5. Electrolyte disturbances:
a. Hypo-kalemia,
b. Hypo-magnesemia,
c. Hypo-calcemia.
Causes:
TdP can be an after effect of a rare disorder called long QT syndrome.
Most people with long QT syndrome are born with it, though the patient can get it later in life.
TdP episodes may be precipitated by the usage of certain drugs.
These drugs are certain antibiotics and antipsychotics
Tricyclic antidepressants may also put the patient at higher risk of TdP.
Certain anti-arrhythmia drugs, which are planned to restore a healthy heart rhythm for people with arrhythmias, are also linked with TdP.
Some of these anti-arrhythmic drugs are:
1.Quinidine
2.Procainamide
3.Disopyramide
Symptoms
TdP can appear without warning.
The patient may rapidly feel the heart beating faster than normal, even when the patient is at rest.
In some TdP episodes, the patient may feel light-headed and faint.
In the most severe cases, TdP can induce cardiac arrest or sudden cardiac death.
1.Nausea,
2.Pallor,
3.Cold sweats,
4.Shortness of breath and
5.Chest pain
Signs:
1.Rapid pulse,
2.Low or normal blood pressure
3.Transient or prolonged loss of consciousness
Diagnosis:
1.ECG:
a.Paroxysms of 5-20 beats, with a heart rate faster than 200 beats per minute.
Sustained episodes are occasionally seen.
b.Progressive change in polarity of QRS about the isoelectric line occurs with complete 180° twist of QRS complexes in 10-12 beats.
c.Usually, a prolonged QT interval and pathological U waves are present.
The most consistent indicator of QT prolongation is a QT of 0.60 seconds or longer or a QTc (corrected for heart rate) of 0.45 seconds or longer.
QTc = QT interval divided by the square root of the interval (in seconds) between the onset of each QRS complex (Bazett's formula).
d.A short-long-short sequence between the R-R interval occurs before the trigger response.
2.Electrolytes; hypo-kalemia, hypo-magnesemia and hypo-calcemia.
3.Cardiac enzymes; assessment for myocardial ischemia.
4.CXR and echocardiography, to rule out structural heart disease.
Short-term treatment
1. Resuscitation
2. Defibrillation:
While torsades is often self-terminating, it may develop into ventricular fibrillation, which requires defibrillation
Intravenous magnesium is the drug of choice for torsades de pointes
Isoprenaline is used as an interim treatment until overdrive pacing can be started
Temporary transvenous pacing can be effective in stopping torsade
Long-term treatment
Patients without syncope, ventricular tachyarrhythmia should be monitored
Propranolol is used
Pacemaker
ECG monitoring

TABLE OF CONTENT
Introduction
Chapter 1 To

• Language: English
• Publisher: Kenneth Kee
• Release date: Apr 16, 2018
• ISBN: 9781370709267

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

Torsade De Pointes,

A

Simple

Guide

To

The Condition,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2018 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Torsade de pointes, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What The patient Need to Treat Torsade de pointes)

This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.

This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Torsades de pointes

What is Torsades de pointes?

Torsades de pointes is a distinctive polymorphic ventricular tachycardia in which the QRS amplitude differs and the QRS complexes seem to twist around the baseline.

Torsades de pointes (French for twisting of the points) is linked with a prolonged QT interval, which may be congenital or acquired

Torsades de pointes is normally not sustained and ceases spontaneously but often returns