Torsades de Pointes

Prolonged  Q-T Syndrome  

Warning Signs & Symptoms

 

Recognizing Torsades Warning Signs, Symptoms and Risk Factors:

Torsades attacks or episodes are caused by a medication the patient has taken within the last 24-48 hours. Check both Torsades inducing drug list charts for your medicines.

These telltale signs can be effective potential warning signs to alert the physician or potential undiagnosed or misdiagnosed Torsades patient. Do not underestimate or dismiss a seemingly insignificant symptom, especially symptoms which are associated with a particular medication. 

Do not let any doctor, friend or family member intimidate you into dismissing your symptoms as psychological or simple spasms.  

You will know better than anyone else, if your symptoms are genuine. Trust your own instincts. How many times have you used an appliance repair technician or mechanic for your car... who did not fix the problem... or created another problem? 

Doctors are no less fallible than anyone else and can be wrong more often than you realize; even nice ones who are doing their best. During the 45 years I suffered undiagnosed Torsades attacks, I had dozens of doctors and a multitude of Emergency room physicians who did not take my symptoms seriously. Not one of them ever found the problem. Don't go through the same thing I did where I had to die while wearing a holter monitor to prove I had a serious problem. 

Go to an electrophysiologist (electro-cardiologist) who specializes in Torsades if you think you may have these symptoms. You don't go to a plumber to fix your electrical wiring in your house. It is the same with your heart. Go to a doctor who specializes in cardiac electrical problems & pacemakers. It is your life you can forfeit if you allow someone else to coerce or bully you from finding a proper medical diagnosis... no matter how well meaning their intentions might be. 

In my opinion, a diagnosis of "coronary or arterial spasms" is nothing more than junk diagnostics like "irritable bowel syndrome" neither of which are anything more than symptoms...  (IBS is caused by dairy cow hormones. Buy hormone free milk)  These labels are not a definitive cause and it saves your medical insurance company the costs of doing a real diagnosis through extensive testing. Watch out for diagnoses of "idiopathic" anything. That means they don't know what is causing it... so that is not a diagnosis either.

Here are some warning signs for someone who may have Torsades or another type of cardiac arrhythmia which may never show up on any EKG or other cardiac diagnostic tests. My tests were always perfect. 

I hope these suggestions & ideas are helpful.

Symptoms:
  • Atypical, paradoxical, racing heart rate or anxiety type reactions to certain medications. Especially important if unusual reactions are to antibiotics, pain meds, sedatives, migraine meds (Zomig), blood pressure medicine (especially Hydralazine) & antidepressants, neurological or psychologist drugs.  
  • Reactions to drugs can occur 24-48 hours after the drug was taken. Or immediately depending on drug type or form. (oral or IV)
  • EKG can appear perfect when patient is not having a Torsades episode. It will also appear perfect 5 minutes after an attack. It leaves no  evidence of an attack.
  • Unusual allergies or reactions (antibiotics) or  arrhythmias or increased PVC reactions  (irregular beats) to numerous medications  (toprol). (other than those reactions of hives or rashes since these  skin related symptoms are not related to Torsades).
  • Sudden unexpected reaction of anxiety, panic or claustrophobia immediately following injection or administration of certain IV medications and can also be caused by oral medications. (This will really sound crazy to any medical professional, however, more than one Torsades patient has described this feeling as “a sudden urge to peel off their skin and run down the hall.” This is a classic reaction specific to Torsades patients after injection or IV drug has been given, although they may hesitate to express this statement to their physician.)
  • Sudden, unexpected significant increase in heart rate immediately following injection or administration of certain IV medications or subsequent to oral drugs as well  (Vancomycin).
  • History of patient complaints of occasional “fluttering sensations,” “irregular or pounding heartbeat” or PVC’s.
  • History of slow heart beat in patient  (mostly at night)
  • History of Prolonged Q-T syndrome
  • History of low blood pressure under age 40
  • History of sudden cardiac death in patient or blood relative
  • Unexplained syncope (fainting) when standing or sitting upright. This is also an indicator for hypostatic intolerance but may also indicate a heart rate drop out or heart block.
  • Unexplained syncope or associated symptoms when taking certain medications.
  • Unexplained onset of chest pain within 48 hours of taking certain medications.
  • Fainting (syncope) or blacking out.
  • Repeated episodes of chest pain while patient is taking certain medications.
  • Previous diagnosis of coronary artery spasms, heart spasms, coronary embolisms, esophageal spasms, chest muscle spasms, Idiosyncratic (unexplained) chest pain, stress or anxiety related chest pain or unexplained heart attack
  • Hypochondraic complaints or previous diagnoses of psychological or psychosomatic related chest pain, hypochondraic related chest pain, Munchausen related chest pain & any aforementioned suspect reactions, other unusual unexplained chest pain or medication related reactions.  (These are often gross misdiagnoses by self centered quacks. Get a new doctor.)
  • Similar familial histories of any similar symptoms or unexplained sudden cardiac deaths
  • Familial history of Torsades.
  • Patients with ischemic or hypoxic damage to the brain may be at higher risk for developing Torsades.
  • Patients with Autonomic nervous system dysfunction may be at higher risk for developing Torsades.
  • Patients with Adrenal Insufficiency or Addisons disease  or on cortisones may be at higher risk for developing Torsades.  
  • Patients with severe imbalance in vitamins or other minerals and nutrients may be at higher risk for developing Torsades.
  • Patients with certain neurological disorders or brain trauma may be at higher risk for developing Torsades.
  • Provide patient with sublingual nitro spray which will stop attacks. 
  • Imdur ER 30-60 mg will prevent attacks. However, the offending drug causing the episodes must be identified & eliminated to stop attacks.
  • NEVER use methadone for any reason. Deadly! 
  • Do not use Zomig or Hydralazine in a suspected Torsades patient. Deadly!

Best Treatments:

  • It  is best to identify drug causing Torsades episodes & eliminate it. That will stop the attacks.  Check lists for every drug before using it.
  • Nitro sublingual spray to stop episodes;  (No more than 3 sprays under tongue) Excessive doses can cause BP drop or stroke.)  Patients should always carry spray with them.  It  should be used immediately without delay if patient detects impending attack. Nitro will not work once fibrillation begins.
  • Imdur ER (Isosorbid) (30-60mg) prn once or twice daily as needed to prevent episodes.  No more than twice daily (16 hours) to prevent nitro from becoming ineffective. The ER extended version is 8 hours.
  • Benadryl pill (25 mg) QD PRN or by IV in hospital. BID if needed to prevent  Torsades attacks, especially in conjunction with  Antibiotic treatments such as Vancomycin, Cipro, Levaquin, etc. Or psychological drug treatments. See drug list.  Use only plain Benadryl Diphenhydramine antihistamine. No combo drugs or decongestants.
  • Beta Blocker or anti-arrhythmia medicine to prevent episodes. I take Bystolic 20 mg QD.
  • Avoid drugs on Torsades list. Each person is different. I can take many drugs safely on the list. Others cannot.
  • Implanted AICD (defibrillator pacemaker).  St Jude is best.
    • 3 month followups unless shock occurs.
  • Control infections, blood pressure & glucose levels.
  • Regular blood tests.
  • Reduce edema in extremities.
  • Control clotting factors
  • Patients with adrenal insufficiency require special care to avoid cortisol withdrawals which cause arrhythmias and other problems.
  • No epinephrine in dental anesthetic injections. Take benadryl 45 minutes before dental procedure.
  • Use only Propoful (Diprivan) anesthesia for surgeries. It is the only drug I allow for surgery. No versed, no paralytics, no succinylcholine, no Ketamine,  no inexperienced anesthesiologists. Require 10 years civilian experience knowledgeable with Torsades.

Diagnostics for Torsades:

  • Torsades attacks or episodes are caused by a medication the patient has taken within the last 24-48 hours. 
  • Check both Torsades inducing drug list charts for patients medicines.
  • Reactions to drugs can occur 24-48 hours after the drug was taken. Or immediately depending on drug dosage, type or form. (oral or IV)
  • When you eliminate offending drug, the Torsades episodes will stop.
  • EKG's can appear perfect when patient is not having a Torsades episode. It will also appear perfect 5 minutes after an attack. It leaves no symptoms or evidence.
  • a holter monitor or a 30 day (or longer) cardiac event monitor is the best diagnostic tool & can best capture the evidence of a Torsades episode. But only if the patient is still taking the drug causing the Torsades attacks. 
  • Nitro sublingual spray will stop attack, But will also prevent capture on recording. 
  • If not stopped, the torsades attack will progress to fibrillation which cannot be stopped by nitro & the patient will die like I did. So it is a catch 22 trying to capture the attack on monitor.
  • As a Torsades index patient with recorded proof of Torsades, I was tested with every cardiac test imaginable and every new Torsades diagnostic devised including DNA. All were negative. So do not assume the patient is safe based on any negative test.
  • Be sure to look at my holter monitor recording of my fatal Torsades attack because it doesn't begin the way you would expect. The classic Torsades rhythm does not occur until the last seconds of death.
  • Family history of sudden Cardiac Deaths.
  • Thorough history of patient symptoms. See list above.
  • Thorough list of all drugs taken by patient during past 6 months including those (as needed) or occasional drugs which patient may not have listed.  Such as for headaches, pain, infections, OTC's, street drugs,  diet drugs, botox injections, cortisone injections, vitamin supplements, allergy meds, asthma sprays, etc.  Most patients do not list these.
  • Have patient keep a daily diary of all drugs taken & food & beverages, symptoms & reactions & activities  as well as psycho-social interactions with others (arguments, stress, intimacy, worry, anger, sadness, divorce, death of close companion, separation, bullying, violence, Allergies, etc.) to determine source of problems.  
  • I know one person who ended up in the ER every holiday when he ate turkey. I know another who was stressed by an oppressive family member. Another had extremely high BP when going to a doctor. White coat syndrome. But not from fear. It was due to extreme frustration with doctors due to failure to find source of problems.
  • Thorough Blood tests monthly or more frequent as needed.
  • Caution:  
    • Patients may have more than one cardiac abnormality or condition in addition to Torsades, which may be overlooked in the process or masked by the presence of other unrelated conditions.  
    • Do not assume the absence of Torsades or other electrical conditions just because the patient has CAD  or valve dysfunction,  or damage from a heart attack, etc. They can still have Torsades.  This is a common error & oversight.

 

 

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