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Diagnostic Topic – Torsade de Pointes
1. What Is This?
The EKG described is showing Torsade de pointes, a specific form of polymorphic ventricular tachycardia associated with a prolonged QT interval. Torsade is a dangerous ventricular arrhythmia that can rapidly deteriorate into ventricular fibrillation and sudden cardiac death if not recognized and treated promptly. It is considered a subtype of wide-complex tachycardia with a characteristic cyclical change in QRS shape and amplitude.
2. What Is the Characteristic EKG Feature?
The most distinctive EKG finding in Torsade de pointes is its “twisting of the points” appearance. This refers to the way the QRS amplitude gradually increases and decreases in a sinusoidal pattern, giving the impression that the complexes are spiraling or “twisting” around the baseline.
Additional key features include:
This unusual undulating pattern is what sets Torsade apart from other forms of ventricular tachycardia.
3. What Clinical Scenario Goes With This EKG?
Torsade can present with a wide spectrum of symptoms, ranging from palpitations to dizziness, syncope, or even sudden cardiac death. You cannot diagnose it based on symptoms alone—the EKG is essential.
Classic exam clues that point to Torsade include:
1. What Is This?
The EKG described is showing Torsade de pointes, a specific form of polymorphic ventricular tachycardia associated with a prolonged QT interval. Torsade is a dangerous ventricular arrhythmia that can rapidly deteriorate into ventricular fibrillation and sudden cardiac death if not recognized and treated promptly. It is considered a subtype of wide-complex tachycardia with a characteristic cyclical change in QRS shape and amplitude.
2. What Is the Characteristic EKG Feature?
The most distinctive EKG finding in Torsade de pointes is its “twisting of the points” appearance. This refers to the way the QRS amplitude gradually increases and decreases in a sinusoidal pattern, giving the impression that the complexes are spiraling or “twisting” around the baseline.
Additional key features include:
- Polymorphic wide QRS complexes (>120 ms)
- Beat-to-beat variation in QRS axis and morphology
- Prolonged QT interval before the onset of the arrhythmia
This unusual undulating pattern is what sets Torsade apart from other forms of ventricular tachycardia.
3. What Clinical Scenario Goes With This EKG?
Torsade can present with a wide spectrum of symptoms, ranging from palpitations to dizziness, syncope, or even sudden cardiac death. You cannot diagnose it based on symptoms alone—the EKG is essential.
Classic exam clues that point to Torsade include:
- Hypomagnesemia—one of the most common metabolic triggers
- Hypokalemia—exacerbates QT prolongation
- Drug-induced QT prolongation, especially from medications such as:
- Tricyclic antidepressants (TCAs)
- Class III antiarrhythmics (amiodarone, dofetilide, ibutilide)
- Macrolide antibiotics (e.g., azithromycin, erythromycin)
- Quinolone antibiotics (rarely)
- Certain antipsychotics and antiemetics
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