1. ECG interpretation
Amarpal Bains

3. ECG Leads Derived leads; I, II, III Limb leads; aVR, aVL, aVF
Precordial leads;
V1, V2, V3, V4, V5, V6

7. Normal Sinus Rhythm Regular, 60-100, P-QRS-T PR interval 0.12-0.2s
QRS <0.12s
No ST changes

9. ECG checklist Patient Identity Rate and Rhythm Axis P waves
PR interval
QRS morphology/duration
ST morphology

10. Torsades de Pointes
Distinctive polymorphic VT where QRS amplitude varies and the complexes oscillate around the baseline because of >QTc
Recurrent syncope/dizziness/palpitations, sudden cardiac death
Congenital, post MI, electrolyte disturbances, DRUGS
Resuscitation, Defibrillation, IV Magnesium, IV Isoprenaline, treat the cause

12. Drugs accepted to increase risk of >QTc/TdP;
Haloperidol, Chlorpromazine, Methadone
Drugs which possibly increase risk of >QTc/TdP;
Risperidone, Quetiapine, Lithium, Clozapine, Escitalopram, Venlafaxine
Inhibit cardiac delayed potassium rectifier channel (IKr) - extends ventricular repolarisation - >QTc

13. Things to consider Detailed cardiac FH/PMH
Screen for electrolyte/metabolic disturbances (U&Es, Mg2+, Ca2+, TFTs)
ECG (QTc >450ms/>470ms)
Age >65/Female are risk factors

14. References
Antipsychotic drugs: A review with a focus on QT prolongation. Journal of Pharmacy and Alternative Medicine ISSN (Paper) ISSN (Online)Vol. 2, No. 4, 2013
Drug-induced Long QT Syndrome. Pharmacol Rev Dec; 62(4): 760–781.
Torsades de Pointes. Professional references, patient.co.uk
Drug-induced QT prolongation and Torsades de Pointes - the facts. Medsafe 31(4): 27-29