Torsades de Pointes

Torsades de Pointes is a rare, dangerous type of fast heart rhythm (tachycardia) that starts in your heart’s ventricles (lower chambers). This condition can cause a heart rate from 150 to 300 beats per minute. A normal pulse rate is 60 to 100 beats per minute. Torsades de Pointes can lead to sudden cardiac death without any warning symptoms.

An electrocardiogram (EKG) will show a specific pattern of ventricular tachycardia that looks like twisting points or peaks (which is what the name means in French).

If you have a long QT interval and your ventricles get an extra beat during the time when they’re supposed to be getting ready for the next beat, you may get Torsades de Pointes. The QT interval is the time between when your ventricles beat (QRS) and when they fully relax before the next beat (T).

Symptoms of Torsades de Pointes

Half of the people with this condition don’t have any symptoms. People who get Torsades de Pointes symptoms can have:

• Dizziness
• Palpitations (feeling your heart pounding)
• Lightheadedness
• Fainting
• Cardiac arrest

Torsades de Pointes causes

Some people are born with long QT syndrome, an electrical problem with their hearts, which can lead to Torsades de Pointes. More commonly, certain medicines and low electrolytes lengthen your QT interval. This can put you at risk for Torsades de Pointes.

Medicines that can cause Torsades de Pointes include:

• Antiarrhythmics
• Antibiotics
• Antiemetics (for nausea and vomiting)
• Antifungals
• Antimicrobials
• Antipsychotics
• Cancer medicines

Risk factors

Some risk factors are harder to control than others. Risk factors for Torsades de Pointes include:

• Having long QT syndrome
• Having heart disease
• Being female
• Being older than 65
• Having an underactive thyroid
• Having a stroke
• Taking diuretics
• Having bradycardia (slow heart rate)
• Having low levels of calcium, magnesium or potassium
• Having excessive diarrhea and vomiting

How to lower your risk

If long QT syndrome runs in your family, a healthcare provider can test you to see if you also have it. If you inherited long QT syndrome from a parent, talk to a heart rhythm specialist before you start an exercise program.

You can reduce your risk of Torsades de Pointes in these ways:

• Ask your healthcare provider for a different drug if you take medicine that can cause a long QT interval.
• Ask your provider to review your medications, especially when they add new ones, to make sure the combination of medicines isn’t increasing your risk.
• Increase your levels of calcium, magnesium and potassium if your provider recommends it.
• Keep taking your approved medicines to keep Torsades de Pointes from happening again.
• Learn how to take your pulse and what’s normal.
• Drink plenty of fluids.
• If your provider gave you a heart monitor, be sure to wear it.

Complications of this condition

Possible complications of Torsades de Pointes include:

• Ventricular fibrillation
• Fainting
• Sudden cardiac death

How doctors diagnose Torsades de Pointes

Your provider can see a long QT interval and a distinct pattern that looks like twisting points or peaks on an electrocardiogram (EKG).

Other tests to diagnose Torsades de Pointes include:

• Blood tests to check electrolyte levels
• Echocardiogram to assess heart structure and function
• A heart monitor you wear at home to record your heart rhythm

How is it treated?

Torsades de Pointes treatment may include medications and procedures. If you inherited long QT syndrome from your parents, your treatment will include more long-term solutions than someone who got a long QT interval from a medication.

Medications

Your provider may stop giving you medicines that could cause Torsades de Pointes. Medicines they may start giving you may include:

• Magnesium and/or potassium
• Isoproterenol
• Beta-blockers

Procedures

Your provider may use one of the following treatments:

• Temporary or permanent pacemaker
• Implantable cardioverter defibrillator (ICD)
• Electrical cardioversion
• Defibrillation

When should I see my healthcare provider?

If you’re in the hospital for Torsades de Pointes, you’ll need a follow-up visit two weeks after you go home. Because of your risk of sudden death, you need regular follow-up visits with a cardiologist (heart expert).

Also, let your provider know if you’ve had bad side effects from medicines.

You should go to the emergency room if you have a very fast pulse rate, you feel palpitations, dizziness or lightheadedness, or you get fainting episodes.

Questions to ask your healthcare provider may include:

• Was I born with long QT syndrome or did I get it from a medication?
• What are the chances that others in my family will have long QT syndrome?
• Is there another medicine I can take instead of the one that put me at risk for Torsades de Pointes?

What can I expect if I have Torsades de Pointes?

You’ll stay in the hospital until your heart rhythm is under control. A fast heart rhythm (ventricular tachycardia) from Torsades de Pointes often stops by itself. But without treatment, it will come back often. It can also lead to ventricular fibrillation.

If you don’t get treatment, Torsades de Pointes could become fatal. With treatment, your chances of survival are good, especially if you stop taking the medicine that caused the long QT interval.