What drug is used for torsades de pointes with Hypomagnesaemia?
Intravenous magnesium is the drug of choice for torsades de pointes. Magnesium is effective even in patients with normal magnesium levels. Acceleration of the heart rate can be achieved by using beta 1-adrenergic agonists such as isoprenaline or overdrive electrical pacing.
What medication reverses torsades Depointes?
Treatment
- beta-adrenergic antagonists, such as propranolol.
- beta-blockers.
- pacemakers.
- implantable cardioverter defibrillator in rare cases.
How is TdP treated?
Immediate treatment of TdP is by intravenous administration of magnesium sulphate, terminating prolonged episodes using electrical cardioversion. In refractory cases of recurrent TdP, the arrhythmia can be suppressed by increasing the underlying heart rate using isoproterenol (isoprenaline) or transvenous pacing.
Do you do CPR for torsades de pointes?
If torsades de pointes is present, then give magnesium 1-2 g diluted in 10 mL D5W IV/IO push, typically over 5-20 minutes (Class IIa for torsades). Continue CPR followed by 1 shock and additional CPR/medications for 5 cycles or 2 minutes.
Which of the following drugs can cause Torsades de Pointes?
Table 2
| Class | Examples |
|---|---|
| Antiarrhythmics | Disopyramide, procainamide, quinidine, sotalol |
| Macrolides | Azithromycin, clarithromycin, erythromycin |
| Fluoroquinolones | Ciprofloxacin, levofloxacin, moxifloxacin |
| Antifungals | Fluconazole, ketoconazole, pentamidine, voriconazole |
Which antiarrhythmic drugs cause torsades pointes?
Antiarrhythmic drugs associated with torsade include the following:
- Class IA – Quinidine, disopyramide, procainamide.
- Class III – Sotalol, amiodarone (rare), ibutilide, dofetilide, almokalant.
Which antibiotics cause prolonged QT interval?
Antimicrobials that are associated with QT prolongation include the macrolides/ketolides, certain fluoroquinolones and antimalarials, pentamidine, and the azole antifungals.
What is the role of magnesium in the treatment of torsade de pointes?
Magnesium is the drug of choice for suppressing early afterdepolarizations (EADs) and terminating the arrhythmia. Magnesium achieves this by decreasing the influx of calcium, thus lowering the amplitude of EADs. Magnesium can be given at 1-2 g IV initially in 30-60 seconds, which then can be repeated in 5-15 minutes.
How does magnesium sulfate treat torsades de pointes?
What happens to the heart during Torsades de Pointes?
In the case of torsades de pointes (TdP), the heart’s two lower chambers, called the ventricles, beat faster than and out of sync with the upper chambers, called the atria. An abnormal heart rhythm is called an arrhythmia. When the heart beats much faster than normal, the condition is called tachycardia.
Do you give amiodarone for torsades?
Lidocaine is the preferred anti-arrhythmic drug for torsades, although there isn’t a ton of evidence supporting its use. Do not use amiodarone, procainamide, beta-blockers, or most other antiarrhythmics.
