What medication should be considered for torsades de pointes?
Intravenous magnesium sulfate, a relatively new mode of therapy for torsade de pointes, was proven to be extremely effective and is now regarded as the treatment of choice for this arrhythmia.
How is torsades de pointes usually treated?
Pulseless torsades should be defibrillated. Intravenous magnesium is the first-line pharmacologic therapy in Torsades de Pointes. Magnesium has been shown to stabilize the cardiac membrane, though the exact mechanism is unknown. The recommended initial dose of magnesium is a slow 2 g IV push.
What antiarrhythmic drugs cause torsades Depointes?
Antiarrhythmic drugs associated with torsade include the following:
- Class IA – Quinidine, disopyramide, procainamide.
- Class III – Sotalol, amiodarone (rare), ibutilide, dofetilide, almokalant.
Which drug out of the following should be given in a patient who develops torsades de pointes?
Magnesium. Magnesium is recommended for the treatment of torsades de pointes VT with or without cardiac arrest, but it has not been shown to be helpful for treatment of non-torsades pulseless arrest.
Do you give amiodarone for torsades?
Torsades de pointes is caused by a prolonged QT. Almost all of the antiarrhythmics that we normally use to treat ventricular tachycardia, such as amiodarone and procainamide, will prolong the QT further, and therefore can make your patient worse. Do not give amiodarone or procainamide.
Can amiodarone cause torsades?
Although amiodarone appears to have few pro-arrhythmic effects, torsade de pointes (TdP) has been observed during long-term drug administration, usually in conjunction with electrolyte disturbances, a change in drug dosage, or concomitant drug therapy.
Why do you give mag sulfate for torsades?
Magnesium sulphate suppresses torsade by decreasing the influx of calcium ions, which in turn results in decreased amplitude of EADs. The initial dose is 2 g (20 ml of 10% solution), given intravenously over one to two minutes.
Is amiodarone contraindicated in torsades?
How do you treat torsades de pointes ACLS?
Key Points Unsynchronized defibrillation is required if a torsades induces ventricular fibrillation. The torsades rhythm is treated with magnesium sulfate 2 g IV over 1 to 2 minutes, correction of hypokalemia, pacing or isoproterenol to increase heart rate, and correction of the cause.
Does amiodarone cause torsades de pointes?
Background Amiodarone is an effective antiarrhythmic drug rarely associated with torsade de pointes arrhythmias (TdP). The noniodinated compound dronedarone could resemble amiodarone and be devoid of the adverse effects.
Does amiodarone lengthen QT?
Abstract. Amiodarone is an antiarrhythmic agent known to cause prolongation of action potential duration which is reflected in the electrocardiogram as a prolongation of the QT interval.
What drugs cause torsade de pointes?
Torsade de pointes is most commonly precipitated by QT prolonging drugs, mainly type IA antiarrhythmic therapy such as quinidine and disopyramide, and other antiarrhythmic agents are reported to cause torsade de pointes as well.
Is drug-induced torsades de pointes an important clinical entity?
This study suggests that drug-induced torsades de pointes is an important clinical entity that occurs more frequently than has been suspected. Full text Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article(1.5M), or click on a page image below to browse page by page.
What are the risk factors for torsade de pointes?
Predisposing factors known to increase the likelihood of developing torsade de pointes are: electrolyte imbalance (hypokalemia, hypomagnesemia, or both) and slow heart rate induced either by sinus bradycardia or heart block. Treatment of torsade de pointes is aimed at shortening the QT interval.
Which drug interactions are associated with drug-induced qtcinterval prolongation and torsades de pointes?
Pharmacokinetic drug interactions associated with the highest risk of drug-induced QTcinterval prolongation and torsades de pointes Precipitant drug Mechanism QTcinterval–prolonging drug Antifungal agents: Itraconazole Ketoconazole Posaconazole Voriconazole