eMedicine Specialties > Emergency Medicine > Cardiovascular

Torsade de Pointes: Differential Diagnoses & Workup

Author: Michael J Bessette, MD, FACEP, Director of Emergency Medicine, Jersey City Medical Center
Coauthor(s): Sheldon Jacobson, MD, Chair, Professor, Department of Emergency Medicine, Mount Sinai Medical Center
Contributor Information and Disclosures

Updated: Jan 25, 2010

Differential Diagnoses

Pediatrics, Tachycardia
Renal Failure, Chronic and Dialysis Complications
Toxicity, Antidysrhythmic
Toxicity, Antihistamine
Ventricular Fibrillation
Ventricular Tachycardia

Workup

Laboratory Studies

  • Potassium, magnesium, and calcium levels

Other Tests

  • Electrocardiogram (ECG): Once in sinus rhythm, examine the QT interval. Typical examples are depicted below.

  • A run of torsade de pointes in a 70-year-old man ...

    A run of torsade de pointes in a 70-year-old man who developed QT prolongation (QTc = 0.61 sec) secondary to quinidine therapy. The bottom strip shows resolution with overdrive ventricular pacing.

    A run of torsade de pointes in a 70-year-old man ...

    A run of torsade de pointes in a 70-year-old man who developed QT prolongation (QTc = 0.61 sec) secondary to quinidine therapy. The bottom strip shows resolution with overdrive ventricular pacing.


  • A patient with prolonged QT and atrial ectopy. St...

    A patient with prolonged QT and atrial ectopy. Strip shows premature beat that entrains and a run of torsade de pointes.

    A patient with prolonged QT and atrial ectopy. St...

    A patient with prolonged QT and atrial ectopy. Strip shows premature beat that entrains and a run of torsade de pointes.

  • Frequent ECG monitoring is indicated for patients who are at risk due to chronic conditions or drug therapy.

More on Torsade de Pointes

Overview: Torsade de Pointes
Differential Diagnoses & Workup: Torsade de Pointes
Treatment & Medication: Torsade de Pointes
Follow-up: Torsade de Pointes
Multimedia: Torsade de Pointes
References

References

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Further Reading

Keywords

torsade de pointes, TDP, torsade, ventricular tachycardia, VT, polymorphous VT, twisting of the point, cardiac syncope, vasovagal syncope, QT syndrome, QT interval, sudden death, unstable heart beat rhythm, TDP rhythm, dysrhythmia, Brugada syndrome

Contributor Information and Disclosures

Author

Michael J Bessette, MD, FACEP, Director of Emergency Medicine, Jersey City Medical Center
Michael J Bessette, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Sheldon Jacobson, MD, Chair, Professor, Department of Emergency Medicine, Mount Sinai Medical Center
Sheldon Jacobson, MD is a member of the following medical societies: American College of Emergency Physicians and American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Theodore J Gaeta, DO, MPH, FACEP, Clinical Associate Professor, Department of Emergency Medicine, Joan and Sanford Weill Medical College at Cornell University; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine
Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gary Setnik, MD, Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School
Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD, Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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