Torsades de Pointes

Prolonged  Q-T Syndrome 

  Preventative Methods

 

Preventative measures & Exceptions:

The 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.

  • Sublingual Nitro Spray
    • A 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 mononitrate)
    • 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. 

     

  • Surgery:

     

    • Imdur ER is 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).
    • Benadryl is also a recommended preventative with the Imdur.
    • Propoful (Diprivan) is the only anesthesia I allow. No versed, no paralytics, no succinylcholine, no ketamine.
    • Require anesthesiologist to have 10 years civilian experience & thorough knowledge of Torsades. 
    • Question anesthesiologist a couple days before surgery in case you need to replace him or her.

     

  • Premedication
    • 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 appointment. 

     

  • Torsades prevention during dental work
    • No epinephrine in the dental anesthetic. 
    • Take a bendryl 45 minutes prior to appointment. 
    • Have Nitro available in hand during dental procedure.

 

 

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