Aashi
Forum Moderator
Topics: 114
Posts: 1,062
|
A 69-year-old woman with a history of severe coronary artery disease and a permanent pacemaker for tachybrady syndrome is admitted for dyspnea secondary to congestive heart failure. Her medications include digoxin, amiodarone, metoprolol, and furosemide. While in the telemetry unit, she develops torsades de pointes. She is initially treated with magnesium, atropine, and potassium. Her resting heart rate now is in the 40s. However, she continues having intermittent runs of torsade. The QT interval is 610 milliseconds. What is the next step in treating this dysrhythmia?
(A) Increase the atrial rate of the pacemaker
(B) Isoproterenol
(C) Procainamide
(D) Change oral amiodarone to intravenous
(E) Defibrillation at 200 Joules
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| CocaCola
Forum Guru
Topics: 35
Posts: 907
|
????
Isoproterenol
It will increase the heart rate and is good for torsades...
___________________
There is one thing we can do, and the happiest people are those who can do it to the limit of their ability. We can be completely present. We can be all here. We can give all our attention to the opportunity before us!!!
|
| MDcooper
Forum Guru
Topics: 211
Posts: 470
|
torsades management with drugs and pacemaker has failed.I will go with A
___________________
live and let live.
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,123
|
I go with C
___________________
The Key to Succeed is Patience.
|
| sarika
Forum Guru
Topics: 195
Posts: 1,200
|
Her resting heart rate now is in the 40s. (A) Increase the atrial rate of the pacemaker
|
| Aashi
Forum Moderator
Topics: 114
Posts: 1,062
|
(A) Increase the atrial rate of the pacemaker
Explanation:
Torsades de pointes is defined as a polymorphic ventricular tachycardia in which the morphology of the QRS complexes vary from beat to beat, with the ventricular rate varying from 150 to 250 per minute. The QT interval is also markedly increased and is usually 600 milliseconds or greater. It occurs in nonsustained bursts. Women are more likely to have QT prolongation secondary to drug therapy. Acquired conditions that predispose toward torsades include hypomagnesemia, hypokalemia, classes IA and III drugs, and interactions between antihistamines and azole or macrolide antibiotics.
Acute treatment includes discontinuation of the offending agent, administration of magnesium, and increasing the resting heart rate with either atropine or overdrive pacing up to a rate of 140/min to prevent the ventricular pauses that allow torsades to originate. Speeding the heart rate with a pacemaker shortens the QT interval and effectively helps reverse the torsade. Isoproterenol is rarely indicated and is dangerous in patients with coronary artery disease because of the positive inotropic effect and an increase in myocardial oxygen consumption. Class IA drugs (e.g., procainamide) and class III drugs (e.g., amiodarone) are also contraindicated because they can prolong the QT interval. Torsades with hemodynamic compromise is an indication for electrical cardioversion
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
|
| |
| | | | | | |
Similar forum topics