Torsades de Pointes (TdP)

Exam Cram

• Torsade de Pointes: means twisting of the points and is an cardiac arrhythmia where the QRS amplitude oscillates between long and short, 'twisting'

• Complications: ventricular tachycardia and asystole

• Diagnosis: ECG

• Management: IV Magnesium 2.5g / 30mins

Outline

Management

1. Unstable: 

   • DC Cardiovert (ischaemia, shock, heart failure, syncope)

   • As per stable management

2. Stable

   • IV Magnesium

   • Stop drugs to prolong QT (macrolides)

   • Aim K + > 4.0, Mg > 1.0, correct Calcium

Of note: amiodarone isn't used for Torsades de Pointes, only for VT (Ventricular Tachycardia). 

Written in 2025. 

Resources and References

1. Cohagan B, Brandis D. Torsade de Pointes. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459388/