What is the first-line treatment for torsades de pointes?

What is the first-line treatment for torsades de pointes?

• A. Oral calcium supplements
• B. IV potassium
• C. Defibrillation
• D. IV magnesium

Answer: (D)

Torsades de pointes is a ventricular tachycardia linked to a prolonged QT, and the key initial fix is intravenous magnesium sulfate. Magnesium stabilizes the heart's electrical activity, reduces the likelihood of early afterdepolarizations that trigger the arrhythmia, and can terminate or prevent recurrence even if magnesium levels are normal. The standard approach is IV magnesium sulfate, often 1-2 g given over a short period, with repeat dosing or a continuous infusion if the rhythm recurs. Other options aren’t as effective for an acute episode: oral calcium won’t address the immediate rhythm disturbance, correcting potassium is only part of the story if potassium is low, and defibrillation is reserved for cases where the patient is pulseless or unstable. If the patient becomes unstable, defibrillation is the next step, but IV magnesium is the first-line treatment for the torsades episode with a pulse.

Torsades de pointes is a ventricular tachycardia linked to a prolonged QT, and the key initial fix is intravenous magnesium sulfate. Magnesium stabilizes the heart's electrical activity, reduces the likelihood of early afterdepolarizations that trigger the arrhythmia, and can terminate or prevent recurrence even if magnesium levels are normal. The standard approach is IV magnesium sulfate, often 1-2 g given over a short period, with repeat dosing or a continuous infusion if the rhythm recurs. Other options aren’t as effective for an acute episode: oral calcium won’t address the immediate rhythm disturbance, correcting potassium is only part of the story if potassium is low, and defibrillation is reserved for cases where the patient is pulseless or unstable. If the patient becomes unstable, defibrillation is the next step, but IV magnesium is the first-line treatment for the torsades episode with a pulse.