Wed3November0903PM 12

A 67-year-old lady is admitted, via the Emergency department to the coronary care unit. She complained of sudden onset palpitations and chest pain. On arrival in CCU she was in atrial fibrillation. The on-call doctor prescribed intravenous amiodarone. This cardioverted to normal sinus rhythm.

Three hours later the patient complains of some chest discomfort. Her blood pressure has remained at 110/70 mmHg and heart rate increased to 190 The 12 lead ECG shows torsade de pointes.

You call for immediate help from the cardiology registrar. She asks you to initiate which of the following treatment options before she arrives to help?

(Please select 1 option)

DC cardioversion

Transcutaneous overdrive pacing

Magnesium sulphate intravenously Correct

Amiodarone intravenously

Flecainide intravenously

Explanation

Drugs which prolong the QT interval (including amiodarone) can lead to torsade. This is a malignant arrhythmia with a significant risk of deteriorating into ventricular fibrillation (VF) and needs prompt treatment.

If any adverse features are present, synchronised DCCV is the treatment of choice. In this case, the patient is stable and may need DCCV.

The initial management of torsade with no adverse features present is:

Stop all drugs which prolong QT

Correct any electrolyte abnormalities

Give IV magnesium (2 g IV over 10 minutes)

The patient may need transvenous overdrive pacing, but expert help is needed for this.

Therefore, the correct answer is magnesium sulphate intravenously.

Answer Statistics

1

6%

2

1%

3

92%

4

2%

5

1%

Times answered: 298