Torsades de pointes 685936 221550178 2008-06-25T00:32:28Z 64.118.218.27 /* Causes */ {{Infobox_Disease | Name = {{PAGENAME}} | Image = | Caption = | DiseasesDB = 29252 | ICD10 = | ICD9 = | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = med | eMedicineTopic = 2286 | eMedicine_mult = {{eMedicine2|emerg|596}} | MeshID = D016171 | }} '''Torsades de pointes''' or '''torsades''' is a [[French language|French]] term that literally means "twisting of the points". It was first described by [[Dessertenne]] in 1966<ref>{{cite journal |author=Dessertenne F |title=[Ventricular tachycardia with 2 variable opposing foci] |language=French |journal=Archives des maladies du coeur et des vaisseaux |volume=59 |issue=2 |pages=263–72 |year=1966 |pmid=4956181 |doi=}}</ref> and refers to a specific variety of [[ventricular tachycardia]] that exhibits distinct characteristics on the [[electrocardiogram]] (ECG). ==Presentation== The ECG reading in torsades demonstrates a rapid, polymorphic ventricular tachycardia with a characteristic twist of the QRS complex around the isoelectric baseline. It is also associated with a fall in arterial blood pressure, which can produce [[fainting]]. Although torsade is a rare ventricular [[Cardiac arrhythmia|arrhythmia]], it can degenerate into [[ventricular fibrillation]], which will lead to sudden death in the absence of medical intervention. Torsade de pointes is associated with [[long QT syndrome]], a condition whereby prolonged QT intervals are visible on the ECG. [[Image:Tosadesdepointes.jpg|right|thumb|Characteristic tracing showing the "twisting" (blue line) of Torsade de pointes]] ==Causes== Long QT syndrome can either be inherited as congenital mutations of ion channels carrying the cardiac impulse/action potential or acquired as a result of drugs that block these cardiac ion currents. Common causes for torsades de pointes include [[diarrhea]], [[hypomagnesemia]] and [[hypokalemia]]. It is commonly seen in malnourished individuals and chronic [[alcoholism|alcoholics]]. Drug interactions such as [[erythromycin]] or [[moxifloxacin]], taken concomitantly with inhibitors like nitroimidazole, dietary supplements, and various medications like [[methadone]], [[Lithium]], [[tricyclic antidepressants]] or [[phenothiazines]] may also contribute. Factors that are associated with an increased tendency toward torsades de pointes include: [[Image:Torsades_converted_by_AICD_ECG_strip_Lead_II.JPG|thumb|right|300px|Lead II [[electrocardiogram]] showing [[Torsades]] being shocked by a [[Implantable cardioverter-defibrillator]] back to the patients baseline [[cardiac rhythm]].]] * [[Familial long QT syndrome]] * Class IA [[antiarrhythmic drug|antiarrhythmics]] * Class III antiarrhythmics * [[Hypomagnesemia]] * [[Hypokalemia]] * [[Hypocalcemia]] * [[Hypoxia (medical)|Hypoxia]] * [[Acidosis]] * [[Heart failure]] * [[Left ventricular hypertrophy]] * [[bradycardia|Slow heart rate]] * [[Female]] gender * [[Hypothermia]] * [[Subarachnoid hemorrhage]] ==Treatment== Treatment is directed at withdrawal of the offending agent, infusion of [[magnesium sulfate]], [[antiarrhythmic drug]]s, and electrical therapy as needed. Because of the polymorphic nature of torsades de pointes, synchronized [[cardioversion]] may not be possible, and the patient may require an unsynchronized shock (or [[defibrillation]]). ==History and terminology== The French term is largely due to the fact that the phenomenon was originally described in a French [[medical journal]] by [[Dessertenne]] in [[1966]], when he observed this rhythm disorder in an 80-year-old female patient with complete intermittent [[atrioventricular]] block. ==References== <references/> [[Category:Cardiac electrophysiology]] {{circulatory-stub}} {{Heart diseases}} [[de:Torsade de pointes]] [[pl:Torsade de pointes]] [[fr:Torsades de pointe]]