In this episode, we cover torsades de pointes, a life-threatening form of polymorphic ventricular tachycardia associated with a prolonged QT interval. We break down the electrophysiology behind delayed ventricular repolarization and early afterdepolarizations, which set the stage for this distinctive "twisting" QRS pattern on EKG. High-yield risk factors—including electrolyte abnormalities (low potassium, magnesium, calcium), QT-prolonging medications, bradycardia, and female sex—are emphasized to help with rapid clinical recognition. We walk through classic presentations such as palpitations, syncope, and sudden collapse, and outline the diagnostic approach with EKG confirmation and targeted lab evaluation. Management focuses on immediate IV magnesium sulfate, correction of underlying causes, and escalation to defibrillation or pacing in unstable or refractory cases.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of ventricular arrhythmias. Circulation. 2018;138(13):e272–e391
3. Drew BJ, Ackerman MJ, Funk M, et al. Prevention of torsade de pointes in hospital settings. Circulation. 2010;121(8):1047–1060