Torsades de Pointes: The Daily PANCE Blueprint

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Torsades de Pointes: The Daily PANCE Blueprint

A 42-year-old male is admitted for typical pneumonia. He is given IV azithromycin and ceftriaxone. His QT interval becomes prolonged and he develops a polymorphic ventricular tachycardia. His blood pressure remains stable. Which of the following is an appropriate pharmacological option?

A. Intravenous calcium gluconate
B. Intravenous magnesium sulfate
C. Intramuscular epinephrine
D. Oral amiodarone
E. Oral procainamide

Answer and topic summary

The answer is B. Intravenous magnesium sulfate

The patient developed Torsades de Pointes(Tdp), which is a specific type of polymorphic ventricular tachycardia in patients with a long QT interval. It is a ventricular dysrhythmia characterized by rapid (>100 bpm), irregular, wide QRS complexes that vary in size and shape. Diagnosis is made via EKG.

Examples of meds that prolong the QT interval include antiarrhythmics (amiodarone, sotalol), antimicrobials (fluoroquinolones, macrolides), antidepressants (fluoxetine, sertraline), and antipsychotics (haloperidol, quetiapine). The treatment is IV magnesium sulfate. Unstable patients need direct current cardioversion

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Covered under ⇒ PANCE Blueprint Cardiology ⇒ Conduction Disorders (PEARLS) ⇒ Torsade de pointes

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