Torsade de pointes is a heart disorder in the form of a rate of beat in the heart chambers (ventricles) that exceeds normal limits. This condition can be caused by congenital abnormalities or side effects of drugs. If not treated immediately, torsade de pointes can cause sudden cardiac arrest.
The heart has four main chambers which are divided into two, namely two lower chambers (cardiac chambers) and two upper chambers (atria). Both of these rooms function to receive and pump blood in the heart.
In torsade de pointes, the heart chambers beat faster and out of sync with the beats in the atria. Please note, the human heart rate under normal conditions is 60−100 per minute. Meanwhile, in torsade de pointes, the chambers of the heart can beat up to 150-300 per minute.
Causes of Torsades de Pointes
Torsade de pointes is a condition in which the chambers of the heart beat faster than normal. This condition can be caused by two things, namely:
Congenital long QT syndrome
Congenital long QT syndrome is a congenital disorder that causes disturbances in the electrical activity of the heart chambers. This syndrome is so named because there is a prolongation of the QRS to T wave interval on the cardiac record ( ECG ) examination.
The more often a person experiences QT prolongation, the higher the risk of developing torsade de pointes.
Drugs
Apart from being caused by congenital abnormalities, torsade de pointes can also be caused by side effects of certain drugs. Some of these drugs are:
- Antifungals, such as fluconazole, ketoconazole, or pentamidine
- Antidepressants, such as citalopram or escitalopram
- Antipsychotics , such as haloperidol or thioridazine
- Macrolide class antibiotics , such as erythromycin, clarithromycin, or azithromycin
- Antiarrhythmics , such as quinidine, procainamide, or disopyramide
- Antiemetics (nausea and vomiting drugs), such as ondansetron , dolasetron, or droperidol
Risk factors for torsade de pointes
The following are several factors that can increase a person's risk of experiencing torsade de pointes:
- Female gender
- Age over 65 years
- Suffering from heart disease
- Have a history of long QT syndrome in the family
- Take diuretics
- Experiencing a slowed heart rate ( bradycardia )
- Have low calcium levels (hypocalcemia), low magnesium levels (hypomagnesemia), or low potassium levels ( hypokalemia )
- Have liver or kidney disease
Symptoms of Torsade de Pointes
In some cases, torsade de pointes don't cause any symptoms. This condition can arise suddenly.
Symptoms that may occur in sufferers include:
- Sudden pounding heart (palpitations).
- Dizzy
- Nauseous
- A cold sweat
- Chest pain
- Hard to breathe
- Feeling like I'm going to faint
- Loss of consciousness
In sufferers of long QT syndrome , the above symptoms can appear because they are triggered by stress, fear, or strenuous physical activity.
When to see a doctor
Get regular health checks if you suffer from or have a family history of long QT syndrome . You also need to consult a doctor regarding the use of drugs that can cause torsade de pointes.
Immediately to the doctor if you often feel your heart beating very fast, accompanied by a sudden feeling of dizziness or fainting. It is important to carry out an early examination to prevent a worse condition from occurring.
Diagnostics of Torsade de Pointes
The doctor will restore the patient's condition first before making a diagnosis. Patients who are brought to the doctor usually have experienced symptoms of torsade de pointes repeatedly.
After recovering the patient's condition, the doctor will ask about the patient's and family's medical history, as well as the medicines the patient is taking. Next, the doctor will carry out a physical examination, such as listening to the heart rate and rhythm, checking the pulse, and checking the patient's blood pressure.
To make a diagnosis, the doctor will carry out several further tests, namely:
- Electrocardiogram (EKG), to record the electrical activity of the heart
- Blood tests , including electrolyte and cardiac enzyme tests , to check electrolyte levels in the body, and detect if there is an interruption in blood flow to the heart muscle
- Scans, such as chest X-rays and ultrasound of the heart ( echocardiography ) , to detect abnormalities in the structure and valves of the heart
Treatment of Torsade de Pointes
Torsade de pointes can cause an emergency condition that results in the sufferer becoming unconscious. If you see someone experiencing this situation, give first aid by performing CPR while waiting for medical personnel to arrive.
If there is an automated external defibrillator ( AED ) near you, then attach the device to the patient's body while waiting for medical personnel to arrive. As well as being able to guide CPR, it can also deliver electric shocks to the heart automatically.
For patients who have been taken to the hospital, the doctor will provide emergency treatment. Some emergency treatments that can be given by doctors are:
- Installation of infusion and breathing apparatus
- Installation of a shock device (defibrillator), to restore a normal heart rhythm
- Electrolyte infusion according to the lack of electrolyte levels that occur
- Administration of magnesium injections
- Administration of isoprenaline drugs, to decrease the QT interval
- Installation of a temporary pacemaker with a tube inserted through a neck vein
Apart from that, doctors can also provide some long-term treatments, such as:
- Administration of beta blockers
- Discontinuation and replacement of drugs that can trigger torsade de pointes
- Placement of a permanent pacemaker if drugs do not improve the patient's condition
- Cutting the left chest sympathetic nerve ( high left thoracic symphathectomy ) if drugs and installation of a pacemaker do not cure the patient's condition
- Insertion of implantable cardioverter-defibrillators (ICD) if all of the above therapies are ineffective
Torsade de Pointes complications
Torsade de pointes is an emergency condition. If not treated immediately, torsade de pointes can cause several serious complications, namely:
- Ventricular tachycardia
- Ventricular fibrillation
- Sudden cardiac arrest
- Dead
Prevention of Torsade de Pointes
The way to prevent torsade de pointes is to reduce the risk of this condition occurring. Some efforts that can be done are:
- Avoid taking medication without a doctor's advice.
- Adopt a healthy lifestyle to avoid heart attacks.
- Take care of kidney health by drinking enough water, and always maintain blood sugar levels .
- Stop smoking habit .
- Apply clean and healthy living behavior ( PHBS ) to avoid severe diarrhea which can lead to hypokalemia.
In addition, there are several steps to reduce the risk of torsade de pointes caused by congenital heart defects , namely:
- Get regular heart checks if you have long QT syndrome or have a family with the condition.
- Consult your doctor before engaging in strenuous activities, such as running a marathon.