Torsades de Pointes

Prolonged  Q-T Syndrome 

 

Diagnostic Methods

 

Diagnostic methods for Torsades de Pointes:

Despite claims from various medical diagnostic equipment companies, there are currently no singularly reliable diagnostic tests (other than the exceptions listed below), which will accurately indicate the presence of Torsades de Pointes other than a holter monitor or EKG recording during an actual Torsades episode producing the unmistakable signature Torsades rhythm. They have tested all of them on me, including the DNA test... not one test has shown my Torsades despite the fact that I'm the only documented, recorded Torsades event patient. Regardless of what the doctors may have been led to believe, none of these tests are reliable. A negative result from any of them means nothing. You or your patient could have Torsades and then be led to believe that a negative result from these tests implies the patient does not have this condition... and that could leave that patient in mortal jeopardy. All of these tests were negative on me and on the rest of my family. If I did not have proof with my holter monitor recording, I would not have any way to prove I had a serious "sudden death" cardiac condition. If your doctor runs these tests and tries to tell you on that basis, that you do not have Torsades... give your doctor this website address and point him or her toward this page because they need to read this information.

Be aware of the fact that the Torsades signature will only last a few seconds at the tail end of a major cardiac fibrillation or sudden cardiac death event. By the time the Torsades signature appears, the heart may have been in fibrillation for more than 7 minutes, by which time irreversible ischemic (stroke) damage to the brain and heart will have already occurred. Therefore it is never recommended, advisable or necessary to produce a Torsades signature rhythm to diagnose a patient for Torsades since the effort would result in the death or permanent damage to the patientís vital organs.

A Physicians first and best starting point consists of good, solid medical detective work. By paying careful attention to a patientís symptoms and complaints, in addition to asking patients key questions about specific details of their personal and familial medical history you can obtain invaluable data about symptoms they may not otherwise think to volunteer.

Carefully review all medications the patient is taking. It is imperative to specifically ask the patient about any additional medications they may only use infrequently including OTC medications, diet aids, herbal, vitamin and mineral supplements and recreational drugs. Physicians often assume that patients have disclosed all information on medicationís they are using, but a very high percentage of patients forget to list infrequently used medications such as migraine medicines, diuretics, antihistamines, cold & flu preparations, aspirin, acetaminophen, Ibuprofen, antacids, asthma inhalers, herbal remedies, vitamins, minerals, health store compounds, diarrhea medicines, old saved prescriptions for treating various maladies, medications prescribed by dentists and other doctors, nitro, epi-pens, health store supplements, borrowed medicines, street drugs, nicotine patches, hormonal treatments, antifungal creams, hemorrhoid preparations, etc. You would be amazed at the number of patients who never think to mention any of these other medications. I was one of them.

Provide the patient with a preprinted list of medications including both the generic and brand names of drugs which can induce a Torsades episode and ask the patient to circle every medication they have taken, the approximate date of the last time the medication was used and have them list any reactions to the drugs on that list. Then ask the patient to provide you with an additional list of any unusual reactions or side effects they have experienced with any medication or anesthesia.

By comparing the patients medication history and reactions to the list of drugs which have been known or suspected of causing Torsades or prolonged Q-T symptoms it will become your best diagnostic tool to detect this elusive condition.  Look for patterns. If necessary, have the patient keep a medication and event diary

 

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