Torsades de Pointes - Tachkardie/en: Unterschied zwischen den Versionen

Aktuelle Version vom 16. April 2019, 22:30 Uhr

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Explanation: TdP tachycardia is the most frequently overlooked special form of polymorphic ventricular tachycardia in which a typical high-frequency, spindle-shaped QRS amplitude fluctuation occurs and is based on the often recurrent intractable ventricular tachycardia.

Predisposing factors are bradycardia and electrolyte disorders such as hypokalemia and hypomagnesemia, which are associated with prolonged repolarization.

It is the classic vital threatening arrhythmia in long-QT syndrome, which, in addition to the rare congenital forms, is now known as v.a in case of drug overdose and as side effect in case of antiarrhythmic drugs (classic in case of quinidine, sotalol, procainamide, flecainid, propafenone, and more rarely amiodarone) or by other drugs (erythromycin, amantadine, pentamidine, ketoconazole, cisapride, probucol, tricyclic antidepressants, etc.).

All different antiarrhythmic drugs are contraindicated in this rhythm disorder, which usually develops from the bradycardia, as they can lead to further bradycardia and prolong repolarization up to the complete heart block under these conditions..

The therapy of choice for TdP is the administration of 1-2 grams of magnesium sulphate (corresponding to 100 - 200mg magnesium) in recurrent TdP tachycardia or of course defibrillation in pulseless TdP with loss of consciousness (= resuscitation) with subsequent magnesium administration..

To prevent the recurrence of TdP, tachycardia of the basic rhythm, to shorten the repolarization period, with pacemaker stimulation is the method of choice. The pacemaker frequency is increased until TdP no longer occurs. This can make a stimulation frequency of up to 120/min necessary in individual cases. Alternatively, an isoproterenolperfusor with the aim of tachycardization can be attempted. However, this therapy regime harbours specific dangers such as circulatory shock caused by proarrhythmia, which is particularly prevalent when there is a replacement rhythm with broad chamber complexes. "Here extreme caution would be required in titrating the correct dose.

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-Erklärung: TdP-Tachykardie ist die am häufigsten übersehene Sonderform einer polymorphen Kammertachykardie bei der eine typische hochfrequente, spindelformige QRS-Amplitudenschwankung auftritt und die oft rezidivierenden intraktablen Kammertachykardien zugrundeliegt.
+Explanation: TdP tachycardia is the most frequently overlooked special form of polymorphic ventricular tachycardia in which a typical high-frequency, spindle-shaped QRS amplitude fluctuation occurs and is based on the often recurrent intractable ventricular tachycardia.
-Prädipositionierende Faktoren sind Bradykardie und Elektrolytstörungen wie Hypokaliämie und Hypomagnesiämie., die mit verlängerter Repolarisation einhergehen.
+Predisposing factors are bradycardia and electrolyte disorders such as hypokalemia and hypomagnesemia, which are associated with prolonged repolarization.
-Sie ist die klassische vital bedrohliche Arrhythmie bei long-QT-Syndrom, welches neben den seltenen angeborenen Formen, heute v.a bei Medikamentenüberdosierung und als Nebenwirkung bei Antiarrhythmika (klassischerweise bei Chinidin, Sotalol, Procainamid, flecainid, Propafenon, und seltener Amiodaron) oder durch andere Pharmaka (Erythromycin, Amantadin, Pentamidine, Ketoconazol, Cisaprid, Probucol, tricyklische Antidepressiva u.a. ) ausgelöst wird.
+It is the classic vital threatening arrhythmia in long-QT syndrome, which, in addition to the rare congenital forms, is now known as v.a in case of drug overdose and as side effect in case of antiarrhythmic drugs (classic in case of quinidine, sotalol, procainamide, flecainid, propafenone, and more rarely amiodarone) or by other drugs (erythromycin, amantadine, pentamidine, ketoconazole, cisapride, probucol, tricyclic antidepressants, etc.).
-''Alle differenten Antiarrhythmika sind bei dieser, meist aus der Bradykardie heraus entstehenden Rhythmusstörung kontraindiziert, da sie zu weiterer Bradykardisierung und Verlängerung der Repolarisation bis hin zum kompletten Herzblock unter diesen Konditionen führen können.''
+''All different antiarrhythmic drugs are contraindicated in this rhythm disorder, which usually develops from the bradycardia, as they can lead to further bradycardia and prolong repolarization up to the complete heart block under these conditions.''.
-''Die Therapie der Wahl bei TdP ist die Gabe von 1-2 Gramm Magnesiumsulfat (entsrechend 100 –200mg Magnesium) bei rezidivierenden TdP-Tachykardien oder natürlich die Defibrillation bei pulsloser TdP mit Bewußtseinsverlust (=Reanimation) mit nachfolgender Magnesiumgabe.''
+''The therapy of choice for TdP is the administration of 1-2 grams of magnesium sulphate (corresponding to 100 - 200mg magnesium) in recurrent TdP tachycardia or of course defibrillation in pulseless TdP with loss of consciousness (= resuscitation) with subsequent magnesium administration.''.
-''Zur Rezidivprophylaxe der TdP ist eine Tachykardisierung des Grundrhythmus, zur Verkürzung der Repolarisationsdauer, mit Schrittmacherstimulation das Mittel der Wahl. Dabei wird die Schrittmacherfrequenz so lange gesteigert, bis keine TdP mehr auftreten. Dies kann eine Stimulationsfrequenz in Einzelfällen bis 120/min notwendig machen. Alternativ kann auch ein Isoproterenolperfusor mit dem Ziel der Tachykardisierung versucht werden. Dieses Therapieregime birgt jedoch spezifische Gefahren wie Kreislaufschock durch Proarrhythmie, die besonders dann bestehen, wenn ein Ersatzrhythmus mit breiten Kammerkomplexen vorliegt. Hier wäre äußerste Vorsicht in Titration der richtigen Dosis geboten.''
+To prevent the recurrence of TdP, tachycardia of the basic rhythm, to shorten the repolarization period, with pacemaker stimulation is the method of choice. The pacemaker frequency is increased until TdP no longer occurs. This can make a stimulation frequency of up to 120/min necessary in individual cases. Alternatively, an isoproterenolperfusor with the aim of tachycardization can be attempted. However, this therapy regime harbours specific dangers such as circulatory shock caused by proarrhythmia, which is particularly prevalent when there is a replacement rhythm with broad chamber complexes. "Here extreme caution would be required in titrating the correct dose.