Torsades de pointes history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Patients who are being evaluated for torsades de pointes should be asked about a history of syncope, and family history of long QT syndrome, sudden cardiac death, or sudden infant death syndrome. Torsades de pointes is associated with a fall in blood pressure, which often gives rise to syncopal symptoms. The patient may experience nausea, shortness of breath, dizziness,chest pain, and possibly ventricular fibrillation and sudden cardiac death.

Torsades is a rapid, polymorphic ventricular tachycardia with a characteristic twist of the QRS complex around the isoelectric baseline. It is also associated with a fall in arterial blood pressure, which gives rise to the syncopal symptoms experienced by patients. Although torsade de pointes is a rare ventricular arrhythmia, it can degenerate into ventricular fibrillation, which will lead to sudden death in the absence of medical intervention.

It is important to gather the following information from the patient:

• History of congenital long QT syndrome
• Family history of sudden cardiac death
• Family history of sudden infant death syndrome
• Family history of congenital deafness (Jervell and Lange-Nielsen syndrome presenting with congenital sensorineural deafness and cardiac abnormalities)
• Family history of congenital long QT syndrome with normal hearing i.e. Romano-Ward syndrome
• Medication history to rule out acquired causes of Torsade de pointes

• Nausea, vomiting
• Shortness of breath
• Chest pain
• Recurrent palpitations
• Dizziness
• Syncope
• Sudden cardiac death