This Rhythm is Not Seen Often - January 2011
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What is this Rhythm?
Do you Know the Warning Signs?
This rhythm is also known as “Twisting of the Points”.
It was first described in 1966 and is a specific variety of
Ventricular Tachycardia (VT) .There are two varieties of VT,
Monomorphic VT and Polymorphic VT.
Distinguishing between the two is a big clue as to what is the rhythm
of the Month. The term Monomorphic means matching wave
forms (the QRS) beat to beat; Polymorphic means the morphology
(of the QRS) changes beat to beat.
This rhythm has long been associated with a prolonged QT interval.
Remember, a normal QT interval is 0.36 seconds to 0.44 seconds.
One of the most common causes of this rhythm is electrolyte abnormalities
such as hypokalemia, hypomagnesemia and hypocalcemia; always monitor
your patient’s electrolytes, you might just avert trouble. Other characteristics
seen may include:
A The rhythm preceded by long and short R to R intervals
B. The rhythm is triggered by an early PVC, such as R on T
This rhythm has been known to cause death.
Treatment modalities may include:
A. Stop offending drugs (Ex: those causing QT prolongation)
B. Give Magnesium, Potassium, or Calicum infusion to correct deficiency
C. Antiarrhythmic drugs
D. Placement of AICDs for rhythm recurrence
E. Any other electrical therapy as needed…however
F. Synchronized cardioversion may not be possible
because of the polymorphic nature, therefore
unsynchronized shock may be needed.
Interpretation: Torsades de Pointes (some might call it Polymorphic VT) 
(Remember, Torsades de Pointes means twisting of the points)