Torsades & Prolonged QT

= a type of ventricular tachycardia
-usually paroxysmal with runs lasting <90s

Unstable
-defibrillate if pulseless (indistinguishable from vfib)
-cardiovert or defibrillate* if unstable with pulse
*cardioversion may not work as the machine may not be able to synchronize with a polymorphic rhythm –> may need to defibrillate even if not pulseless

-do NOT give amio or procainamide – these worsen QT prolongation

Stable**
(1) give 2g magnesium sulfate over 2m
(2) increase HR in order to decrease QT interval
—-overdrive pacing (transvenous preferred) with rate for capture usually 110 or higher
—-chemical overdrive pacing via isoproterenol drip (beta1 & beta2 agonist) at 5 mcg/min (ONLY if acquired, NOT congenital)
(3) consider lidocaine (suppresses early after-depols and thus PVCs)
**May try cardioversion even if stable

Prolonged QT
(1) give 2g magnesium sulfate over 2m to prevent (or treat) torsades
(2) correct hypomagnesemia, hypokalemia, & hypocalcemia
-note: if pt found to have torsades, baseline QT prolongation is not always apparent

Screen Shot 2017-08-12 at 8.32.26 PM
Non-Torsades Polymorphic VT

-usually due to ischemia and accompanied by chest pain and ischemic EKG findings
-as opposed to torsades, amio and beta blockers (ex: esmolol) are indicated

 

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