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Torsades de pointes on an ECG strip

Polymorphic VT that twists around the baseline in spindles, following a long QT.

What to look for

Polymorphic VT with a long QT. The complexes grow, shrink and flip from one side of the baseline to the other, twisting around it in spindles. To call it torsades, you need a prolonged QT before the run, as there is here. A PVC on the T wave (R on T) sets it off. It may stop on its own, or it may degenerate into VF.

Examples

Each strip is 6 seconds of lead II, drawn to scale (25 mm a second, 10 mm a millivolt), so you can count boxes the way you would on paper. Each one is a different example, measured below it.

Example 1 · lead II · 6 seconds
II25 mm/s · 10 mm/mV
Rate
263/min during the run22 QRS complexes in 6 seconds × 10 = 220/min
Rhythm
Irregular
P waves
Upright in II before the run; not seen during it
P to QRS
1:1 before the run; none during it
PR
0.18 s
QRS
0.09 s, narrowThe beats before the run
Example 2 · lead II · 6 seconds
II25 mm/s · 10 mm/mV
Rate
252/min during the run22 QRS complexes in 6 seconds × 10 = 220/min
Rhythm
Irregular
P waves
Upright in II before the run; not seen during it
P to QRS
1:1 before the run; none during it
PR
0.17 s
QRS
0.07 s, narrowThe beats before the run
Example 3 · lead II · 6 seconds
II25 mm/s · 10 mm/mV
Rate
198/min during the run18 QRS complexes in 6 seconds × 10 = 180/min
Rhythm
Irregular
P waves
Upright in II before the run; not seen during it
P to QRS
1:1 before the run; none during it
PR
0.17 s
QRS
0.08 s, narrowThe beats before the run

Don't confuse it with

Want a new strip every time? The ECG Drill in the app draws a fresh, measured example on every try and steers you toward the rhythms you miss. It's part of the Paramedic level, and you can try 5 strips a day free.

Try the ECG Drill

Where the criteria come from

Others in the Ventricular group