Torsades de Pointes - Recognizing Symptoms, Causes, Diagnosis, and Treatment

Understanding Torsades de Pointes: A Comprehensive Overview

Torsades de Pointes is a medical condition involving ventricular tachycardia, in which the lower heart chambers (ventricles) beat more rapidly than the upper heart chambers (atria). This condition can lead to a heartbeat between 150 and 300 beats per minute, compared to the normal range of 60 to 100 beats per minute.

This medical condition can resolve on its own, but it can also be life-threatening in severe cases, causing death due to cardiac arrest. Therefore, it is essential to recognize its symptoms early on and consult a healthcare professional for effective treatment.

Read more to understand its symptoms, causes, risk factors, diagnosis, and treatment.

What are the Symptoms of Torsades de Pointes?

It is not always easy to recognize Torsades de Pointes because about 50% of patients do not have any symptoms. However, in certain cases, Torsades de Pointes causes the following signs and symptoms:

• Heart palpitations
• Higher pulse rate (tachycardia)
• Dizziness
• Fainting (syncope)
• Lightheadedness
• Chest pain
• Nausea
• Cold sweats
• Shortness of breath
• Low blood pressure
• Cardiac arrest
• Sudden cardiac death

What Causes Torsades de Pointes?

An unusual type of heart rhythm disturbance called the Long QT Syndrome results in Torsades de Pointes. Patients with the syndrome exhibit a prolonged QT interval in their Torsades de Pointes ECG or electrocardiogram.

Additionally, Torsades de Pointes can occur due to the inheritance of Long QT syndrome or, more commonly, because of certain medicines that can induce the former. These medications adversely affect the electrical activity of the heart.

These can be:

• Antifungals
• Some antibiotics
• Antiarrhythmics (for irregular heart rhythm)
• Antipsychotics
• Antidepressants
• Antiemetics (for nausea and vomiting)
• Diuretics
• Cancer medications
• Opioids

Torsades de Pointes can also develop due to the following medical conditions:

• Bleeding within the skull
• Electrolyte imbalances
• Coronary artery blockage
• Kidney damage
• Liver failure
• Anorexia
• Malnutrition
• Toxins from insecticides and heavy metals

What are the Risk Factors for Torsades de Pointes?

High-risk factors for Torsades de Pointes can be:

• Genetic predisposition to Long QT syndrome
• QT interval prolonging drugs
• Electrolyte imbalances such as low potassium, magnesium, and calcium levels
• Cardiac disease, such as ischemia
• Being a female
• Being 65 years or older
• An extremely slow heart rate or bradycardia
• Excessive diarrhea and vomiting
• Enlargement of the left heart ventricle
• Hypothermia
• Hypothyroidism

How is Torsades de Pointes Diagnosed?

Accurate diagnosis of Torsades de Pointes is crucial to differentiate it from other kinds of ventricular tachycardia, i.e., caused by reasons other than Long QT interval syndrome.

Medical professionals usually diagnose long QT intervals and Torsades de Pointes by the following tests:

1. Electrocardiogram (ECG or EKG)

This easy-to-perform and reliable test measures the heartbeat as electrical impulses. Electrodes placed on the chest and legs help record the heart rhythm:

• The electrocardiogram displays electrical impulses of the heart as waves, denoted by the letters P, Q, R, S, and T.
• The electrical activity of the heart between the Q and T waves shown on the electrocardiogram is called the QT interval. If this interval is unusually and abnormally prolonged, one is at a higher risk of Torsades de Pointes. 
• The waves in the electrocardiogram form characteristic twisted peaks of short and long electrical impulses, indicating prolonged QT intervals and Torsades de Pointes. So, a Torsades de Pointes ECG diagnoses the condition perfectly.

2. Detecting Electrolyte Levels

Doctors can also diagnose Torsades de Pointes by checking the blood levels of electrolytes like potassium, magnesium, and calcium.

Electrolytes help conduct electrical impulses in the heart and keep a steady and stable heart rate. Low potassium (hypokalemia) and low magnesium (hypomagnesemia) levels in the blood are classic indicators of a prolonged QT interval due to disruption of the conduction of electrical impulses.

3. Wearable Heart Monitoring at Home

The electrical activity of the heart can be monitored at home, which can be done by:

1. Holter Monitoring

Holter monitoring is a unique diagnostic method for detecting cardiac conditions, including long QT intervals and Torsades de Pointes. A small portable device (Holter) is worn for 1-3 days while the patients perform their routine activities.

The Holter records the heartbeat or electrical activity of the heart during this period. A healthcare professional then obtains an electrocardiogram using the information on the Holter to assess the QT interval length and subsequent Torsades de Pointes.

2. Event Recorder

This diagnostic method also employs a mobile device that needs to be worn for up to one month or until key symptoms present themselves. The patient switches on a button to note any arising symptoms.

3. Tech Monitors

With the advancement of technology, some wearable devices like smartwatches also have the option of electrocardiogram monitoring. However, before monitoring yourself using such devices, it’s essential to consult with your healthcare provider.

How is Torsades de Pointes Treated?

Torsades de Pointes treatment can be for both congenital Long QT syndrome and one induced by medicine.

In the case of medicine-induced Torsades de Pointes, a medical professional can withdraw medicines that prolong the QT intervals or give alternatives to treat it. Medical devices can also be used for the condition.

The medicines given for Torsades de Pointes treatment can be :

• Magnesium and /or potassium salts to correct electrolyte imbalance
• Beta-blockers such as propranolol
• Mexiletine (used in combination with a beta-blocker)
• Isoproterenol
• Atropine

Medical devices used to treat this condition include:

1. Implantable Cardioverter Defibrillator

This is a battery-run medical device implanted under the skin. It spontaneously detects and revives the normal rhythm of the heart. An implantable cardioverter defibrillator can be a boon for a patient in cardiac arrest in severe cases of Torsades de Pointes.

2. Electrical Cardioversion

This method uses an electric current to revive the heart's normal rhythm and prevent further arrhythmias. It stops the heart temporarily to restore the functioning of the heart cells.

3. Cardiac Pacemaker - Temporary or Permanent

This device can also be implanted under the chest in case of Torsades de Pointes, to increase the heart rate and regulate the heart rhythm.

Torsades de Pointes is a heart condition involving rapid heart rate or tachycardia. Recognizing symptoms like fainting, palpitations, and dizziness is vital for quick and effective treatment. Consult a healthcare provider to make a customized plan to treat your condition to ensure a balance of optimum health and finances.

Furthermore, based on the patient’s condition, Torsades de Pointes treatment costs can be on the higher side. In this regard, having a health insurance plan can ensure that you gain access to quality treatment without any delays due to inadequate finances.  

At Star Health, our insurance policies cover a wide range of medical conditions. We also provide hassle-free claim settlements with reduced turnaround time across over 14,000 network hospitals in India.

Call us now for further details!