I47.0-2/I47.9
Torsades de pointes Ventricular Tachycardia (VT) has a twisting pattern to the QRS complexes and a prolonged QT interval in sinus rhythm. It is usually due to a QT-prolonging medication, active myocardial ischaemia and/or hypokalaemia and/or a history of alcohol abuse/malnutrition.
GENERAL MEASURES
Defibrillation, as necessary.
Torsades complicating bradycardia: temporary pacing.
MEDICINE TREATMENT
Stop all QT-prolonging medicines (a list of medicines that cause QT prolongation can be viewed at https://www.sads.org.uk/drugs-to-avoid/?doing_wp_cron=1585301751.3996679782867431640625
Correct serum potassium.
- Magnesium sulphate, IV, 2 g administered over 5–10 minutes.
If recurrent episodes after initial dose of magnesium sulphate:
- Magnesium sulphate, IV, 2 g administered over 24 hours.
Torsades complicating bradycardia:
- Adrenaline (epinephrine) infusion to raise heart rate to >100 bpm (if temporary pacing unavailable).
REFERRAL
All cases of wide QRS tachycardia, after resuscitation and stabilization.