What is Torsades de Pointes?

Torsades de pointes (“twisting of the points”) is a life-threatening heart rhythm disturbance.

Irregularities in the heart rhythm are called arrhythmias. A sudden increase in heart rate above the usual levels is called tachycardia. Torsades de pointes (TdP) is a rare form of tachycardia arrhythmia where the heart’s two lower chambers beat faster than, and out of sync with, the two upper chambers.

Typically, TdP resolves without intervention or treatment. However, left untreated, it can potentially develop into a serious heart condition called ventricular fibrillation, which can lead to cardiac arrest (the heart suddenly stops). Cardiac arrest is often fatal.

Symptoms

Torsades de pointes symptoms vary from individual to individual and can occur suddenly without warning. TdP symptoms can be “unsustained” or temporary before going away naturally. TdP can also be “sustained,” which means the TdP interrupts the normal functioning of the heart. Sustained symptoms require urgent medical attention as Torsades de pointes can escalate into serious and sometimes fatal heart complications.

TdP symptoms include the following:

• Increased heart rate
• Dizziness
• Rapid pulse
• Cold sweat
• Lightheaded
• Low blood pressure
• Nausea
• Chest pain

In some serious cases, Torsades de pointes can precipitate unconsciousness (passing out), a condition known as syncope.

Causes

There are several known Torsades de pointes causes. TdP can develop as a complication of QT syndrome, an uncommon condition where the gap between the Q and T wave in the heart is abnormally long. Your heartbeat operates by a series of electrical impulses. The Q and T waves are two of five electrical waves in the heart tracked by an electrocardiogram (EKG) machine.

TdP can also be triggered by certain medications, including antidepressants and anti-arrhythmia drugs.

Additional risk factors for Torsades de pointes:

• Low potassium in the body.
• Low magnesium in the body.
• Low calcium in the body.
• Anorexia (eating disorder).
• Presence of liver disease.
• Bleeding inside the cranium (skull).
• Blockage in a coronary artery.
• Toxins from heavy metals or insecticides.
• Gender (Females are more likely than men to develop TdP).

Diagnosis

 For the best health and wellbeing outcomes, it is essential to accurately diagnose Torsades de pointes and differentiate it from other similar or related heart complications. Torsades de pointes can be diagnosed by assessing an individual’s calcium, magnesium, and potassium levels, but the best way to diagnose this condition is through an electrocardiogram (EKG).

An EKG measures the electrical currents in the heart and displays them as waves (wavy lines) on a screen. Doctors examine the waves for irregularities. These irregularities often take on distinctive shapes, as is the case for Torsades de pointes, which appears on the EKG screen as twisted ribbon.

While arrhythmias are common, they can also be serious if left untreated. Immediate medical care is strongly recommended anytime you experience an irregular (faster, slower or unusual) heartbeat. The outlook and prognosis for treated TdP is optimistic (successful treatment and survival rates are very high).

Treatment

Treatment for Torsades de pointes varies by individual medical condition, medical history, symptoms, and specific cause of TdP. The first step of Torsades de pointes treatment is usually for a doctor to check your calcium, magnesium and potassium levels. If your doctor discovers lower than usual levels, he or she may prescribe supplements.

Other Torsades treatments include:

• Addressing any underlying medical conditions that may be causing TdP. If you have acquired TdP, you may not receive treatment specific to it, as the condition typically dissipates naturally once the underlying condition is resolved.
• If medication is causing the TdP, your doctor may prescribe alternative medications.
• For a congenital form of TdP, your doctor may prescribe beta blockers, along with inserting a pacemaker or (in rare cases) an implantable cardioverter defibrillator.
• If you do not experience syncope, ventricular tachycardia, or have a family history of the condition, you may be monitored by your doctor without any specific additional treatment.