Preventative measures & Exceptions:
recommendations I am providing under this section are directly related to my
personal experience and what I have found by trial and error that works for my
Torsades condition. The opinions and conclusions expressed in this section, have
been drawn from those personal experiences. I am hoping this info will be
helpful to attending physicians who encounter a Torsades patient. This info is
not limited to the field of cardiology. My family physicians were the first line
of defense in my survival for the first 45 years until I was diagnosed.
Torsades episode (attack) can be counteracted with Nitroglycerin
if administrated prior to the onset of fibrillation. Once the warning pain
of an oncoming Torsades attack occurs, the patient has approximately 1-2
minutes to use the Nitro before the onset of fibrillation. Sometimes, less
than a minute. Time is of the essence. I recommend using the nitro
immediately without hesitation. Sublingual nitro spray saved my life more
than 300 times over a 15 year period prior to being diagnosed with Torsades.
I had insisted on having the nitro spray even though my doctors did not
perceive my symptoms warranted it. However, each doctor humored me over the
years since I can be very insistent. That instinct, kept me alive in the
interim. Sublingual Nitro spray is the media I recommend. It lasts for years
and does not deteriorate like the tablets. It is better to err on the side
of precaution by providing the nitro spray to a patient who complains of
unexplained heart pain. This could save their life. Just be sure to fully
explain to the patient, the proper use of a sublingual nitro spray, the
intense short term headache they will experience, the timeline of how many
sprays can be used and the serious dangers of excessive dosing such as
sudden drop in BP and stroke. Also be sure to explain that the nitro will
not work if fibrillation occurs and how fibrillation is characterized by
deep, breathless gasping for air due to lack of oxygen and thus is
imperative to call 911 without delay. Also caution the patient about
safeguarding the nitro from access to small children. It is necessary to
impart this information because most patients wonít take the time to
understand and research in-depth medical details and wont realize the
potential consequences. An added benefit to Nitro is that it will also stop
an esophageal spasm, angina and it will come in handy if the patient has an
occlusion of the arteries or unexpected heart attack. My personal opinion is
sublingual nitro should be changed to an OTC drug accessible to anyone over
18 and included with every home or office medical kit such as the consumer
defibrillators now available on open market.
- Imdur (isosorbide
- This can be
another lifesaving medication for a Torsades patient and can block the
Torsades reaction from occurring even if a trigger medication is taken.
However, Imdur is an 8 hour drug which will cause gnawing headaches for
about a month. I find there is a noticeable difference in efficacy between
the brand name Imdur and each of the generic versions. I always insist on
the brand name. By taking Imdur in conjunction with drugs like Levaquin,
Cipro, Diflucan & Bactrim, as
well as epinephrine,
I have been able to safely use these Torsades trigger medications without
any negative reaction. This must be strictly controlled to avoid setting off
a Torsades episode. Keeping in mind that the Imdur lasts 8 hours, the
patient may have to take a second dose of Imdur for any trigger medicine
requiring more than one daily dose such as Cipro. However, even with Imdur,
an IV or injection of any of those same trigger drugs would result in sudden
cardiac death. Only the oral doses can be safely used with Imdur.
- Imdur ER
also a wise precaution for Torsades patients undergoing surgery. Especially
those surgeries using electrocautery requiring an AICD defibrillator to be
temporarily disabled. (See more under surgery precautions).
is also a recommended preventative with the Imdur.
- Propoful (Diprivan)
is the only anesthesia I allow. No versed, no paralytics, no
succinylcholine, no ketamine.
anesthesiologist to have 10 years civilian experience & thorough
knowledge of Torsades.
a couple days before surgery in case you need to replace him or her.
- For patients with
AICDís who plan to have any dental work or cleaning performed, I highly
recommend the patient to be informed about taking premeds within 1 hour of
treatment. I usually take 4 ampicillinís, amoxicillin or Ceflex for dental
appointments, but the premeds prescribed should be appropriate for each
patient since allergies and reactions vary for each person and situation.
For females, they may also need a yeast medication following each
- Torsades prevention during
- No epinephrine in the
- Take a bendryl 45
minutes prior to appointment.
- Have Nitro available in
hand during dental procedure.