Medical Surgical EKG #14

Question

The nurse is caring for a client who has hypomagnesaemia and hypokalemia. While watching the telemetry monitor, the nurse notices a twisting of the QRS complexes and immediately informs the health care provider that the monitor reveals which abnormality.

Answers

  1. Type III AV block
    • Rationale:

      This answer is not correct because third degree AV block or complete heart block is where there is no conduction through the AV node, which causes complete dissociation between the atria and ventricles. The ECG will reflect no relation between the P-waves and the QRS complexes. Torsade de pointes is characterized by long QT intervals and irregular QRS complexes that seem to be twisting around the ECG baseline, isoelectric line. Due to this twisting around the ECG baseline, it is also called “twisting of the point”.

  2. First degree AV block
    • Rationale:

      This answer is not correct because a first degree AV block has a normal QT interval, QRS complexes, but has PR intervals exceeding 0.20 in first degree heart block (normal PR interval is 0.12 – 0.20 seconds). Torsade de pointes is characterized by long QT intervals and irregular QRS complexes that seem to be twisting around the ECG baseline, isoelectric line. Due to this twisting around the ECG baseline, it is also called “twisting of the point”.

  3. Paroxysmal atrial tachycardia
    • Rationale:

      This answer is not correct because paroxysmal atrial tachycardia is a heart arrhythmia that starts off slow (bradycardia) then has a heart rate of more than 100 bpm, then returns to normal. The P waves in paroxysmal atrial tachycardia originate from the atria, not the SA node. The rhythm also shows narrow QRS complexes in the ECG. Torsade de pointes is characterized by long QT intervals and irregular QRS complexes that seem to be twisting around the ECG baseline, isoelectric line. Due to this twisting around the ECG baseline, it is also called “twisting of the point”.

  4. Torsade de pointes
    • Rationale:

      This answer is correct because Torsade de pointes is a type of ventricular tachycardia (VT). This polymorphic VT is characterized by long QT intervals and irregular QRS complexes that seem to be twisting around the ECG baseline, isoelectric line. Due to this twisting around the ECG baseline, it is also called “twisting of the point”. This dangerous rhythm may precipitate ventricular fibrillation, a deadly arrhythmia.

Overview

Torsade de pointes (French meaning “twisting of the peaks”) is a type of ventricular tachycardia (VT). This can be caused by hypomagnesaemia and hypokalaemia.

Explanation

Learning Outcomes

Torsade de pointes (French meaning “twisting of the peaks”) is a type of ventricular tachycardia (VT). This polymorphic VT is characterized by long QT intervals and irregular QRS complexes that seem to be twisting around the ECG baseline, isoelectric line. Due to this twisting around the ECG baseline, it is also called “twisting of the point”. This dangerous rhythm may precipitate ventricular fibrillation, a deadly arrhythmia. Alcohol abuse can be associated with this occurrence. Also, hypomagnesaemia and hypokalemia can cause this dysrhythmia therefore, careful monitoring of these electrolytes will help prevent this arrhythmia. The nurse should anticipate orders from the healthcare provider to administer an IV infusion of magnesium and potassium. The nurse should also monitor and anticipate treatment for delirium tremens (DTs).

Test Taking Tip

Torsade de pointes has a French origin meaning “twisting of the peaks”. It is also called “twisting of the points”. Using this can help the student recognize this cardiac arrhythmia.

Video Rationale