Torsades de Pointes

Prolonged  Q-T Syndrome

 Diagnostic Tests

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Efficacy of Diagnostic Tests and Procedures:

  • Check the 2 drug lists for medications your patient is taking. Torsades episodes are caused by certain drugs. The episodes will stop once the offending drug has been eliminated.
  • Never use a suspect medication to test a patient for the presence of Torsades de Pointes. This is likely to end with bad results such as a dead or permanently damaged patient and a plethora of legal problems.
  • Diagnosis of prolonged Q-T syndrome can be a strong indicator of the presence of Torsades. Patient should be immediately referred to a competent electrophysiologist with experience in Torsades, for further evaluation.
  • Patients continuing to incur unexplained chest pains despite normal cardiology diagnostic workup & elimination of other suspect medical conditions should be immediately referred to a competent electrophysiologist with experience in Torsades, for further evaluation.
  • Patients with unusually slow heart beats or intermittent heart rate drop outs should be immediately referred to a competent electrophysiologist for further evaluation.
  • Certain few electrophysiologists with specialized experience in Torsades can detect a miniscule flattening present in the heart rhythm of some Torsades patients, which would otherwise be overlooked or interpreted as a normal EKG on a standard cardiac diagnostic workup.
  • Abnormal Potassium, Calcium or Magnesium levels may lead to a Torsades event but are not typical. Magnesium will not stop a torsades episode unless the patient truly has low magnesium levels.
  • Nitroglycerine will stop a Torsades episode if used without Delay. 1 or 2 sublingual sprays. Once fibrillation begins, nitro will not work..
  • Patients with unexplained syncope when standing or sitting upright should be evaluated for hypostatic intolerance, heart rate dropout and referred to a competent electrophysiologist with experience in Torsades for further evaluation.
  • Patients exhibiting any of the aforementioned warning signs or symptoms should be immediately referred to a competent electrophysiologist with experience in Torsades, for further evaluation.
  • Echocardiograms will not indicate the presence of Torsades and will have normal test results unless other unrelated conditions are present.
  • Nuclear stress tests will not indicate the presence of Torsades and will have normal test results unless other unrelated conditions are present.
  • EKG will not indicate the presence of Torsades unless recording at the moment of a Torsades episode, otherwise it will have normal test results unless other unrelated conditions are present.
  • CT scans will not indicate the presence of Torsades and will have normal test results unless other unrelated conditions are present.
  • MRI scans will not indicate the presence of Torsades and will have normal test results unless other unrelated conditions are present.
  • Heart catheterization procedures will not indicate the presence of Torsades and will have normal test results unless other unrelated conditions are present.
  • Holter monitor will not indicate the presence of Torsades unless recording during an actual Torsades episode and will otherwise have normal test results unless other unrelated conditions are present. It may be necessary to make special provisions to run a holter monitor recording for multiple days in order to capture a Torsades event. It is recommended that cardiologists should continue to stock the older style cassette holter monitors and additional supplies in order to allow the patient to wear the monitor for multiple days if needed. The newer electronic holter monitors cannot be extended beyond 24 hours requiring the patient to come into the office on a daily basis for another unit. This is expensive and stressful for the patient and overtaxing for the staff and equipment inventory.  
  • A 30 day (or longer) cardiac event monitor may capture a Torsades episode but only if the patient is still taking the offending drug which instigated the Torsades attacks.
  • Electrical stimulation of the heart via a cardiac catheterization procedure is an ineffective method of detecting or reproducing the presence of Torsades despite claims to the contrary. It failed to show Torsades on a known Torsades index patient.  (myself) It is a high risk procedure which is not reliable.
  • T-wave assention tests have proved ineffective in detecting Torsades when tested on a Torsades index patient (myself) despite manufacturers claims to the contrary.
  • Portable cardiac Fib or event loop recorders may be helpful in ascertaining the presence of a serious heart arrhythmia or unexplained fibrillation by allowing the patient to record intermittent cardiac events at the moment of onset when standard cardiac diagnostics are normal or inconclusive. However, these loop recorders cannot provide enough detailed information to distinguish the event as Torsades, but an important tool to detect the presence of some elusive cardiac conditions.
  • DNA tests may be effective in some forms... but the DNA test was negative on me

 

 

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