okay in our video series of ECG interpretation Made Easy in this video we are going to talk about ventricular Rhythm polymorphic or ventricular tachycardia and dorsards the points now the electrical activity of the heart is controlled by SA node snode produces electrical currents that spread throughout the Atria and causes contraction of the Atria these electrical signals travel through the internodal pathways to the AV nod and from AV node these travel to the bundle branches and purkanji fiber and travel to the ventricles resulting in contraction of the ventricles no if SC node fails to produce these electrical currents AV node takes control over the pacemaker activity of the heart and if AV node fails per kanji fibers start producing electrical activity resulting in contraction of the heart muscles now what if the purkinje fiber also fails that results in the ventricles to generate the electrical activity the ventricles itself start depolarizing producing electrical activity and result in depolarization that is called as a ventricular Rhythm now in some cases damage to the myocardial tissue myocardial ischemia can result in ectopic Foci in the heart that can produce electrical current and those electrical current depolarize the ventricles now these ectopic Foci will produce electrical currents and they will result in ventricular tachycardia result in a rapid rate of heart and these QRS complexes are wide they will result in ventricular tachycardia now if one focus is predominantly producing electrical currents there are many Foci that are producing these electrical Rhythm but if one of the focus is dominant over the others it will produce monomorphic ventricular tachycardia where the shape of the QRS complex will be same since the origin is from one ectopic Focus since the one ectopic focus is dominant over the others it will produce a monomorphic the same shape of QRS complexes in the ECG now there are many ectopic Foci present in The ventricle that are producing and generating these abnormal rhythms if one gets terminal it produces a monomorphic ventricular tachycardia but if all of them are equally dominant over each other it will produce a ventricular tachycardia that is called as a polymorphic ventricular tachycardia which is actually a sum of all these different ectopic Foci producing electrical currents so if multiple Foci are producing electrical currents at the same time those electrical currents join to form a tachycardia that is called as a polymorphecticardia where there are different shapes of the ventricular rhythms that is called as a polymorphic ventricular tachycardia and this is how it looks like torsars the points is a type of polymorphic ventricular tachycardia a most famous type of polymorphic ventricular tachycardia is tors shards polymorphic ventricular tachycardia is basically an irregular grouping of ventricular tachycardia that results in torsoids the points towards Hardy points is a type of polymorphic ventricular tachycardia where multiple poki in the ventricles are producing these electrical currents and these multiple Foci join together to form a polymorphic ventricular tachycardia with different morphology now torsar Depo points is a French word which means twisting of the points now if you focus in these type of rhythmias what you will see is that at one side there will be pointing of the QRS complexes there will be points and on the other side you will see that the QRS complexes will be round so this over here in this part you can see that the pointing is present in the downward Direction so the points are downward over here and then those same points are upward in this part over here these are the points and over here these are the round parts so the points have now pointed upward so that is called as a twisting around the points that is dorsards the points now if you look at this ccg in this ECG the patient was already not having a normal Rhythm but then the patient developed a polymorphic ventricular tachycardia and look over here this is the polymorphic ventricular tachycardia it is the twisting around the points these are the points look at the points and these are the round waves these are the points look at the points and these are the round parts so this is called as twisting of the points or swords the points which is a polymorphic ventricular tachycardia multiple fociabating at the same time and those okay jumble up to form this type of polymorphic ventricular tachycardia now the causes of thoughts are the points includes antiarrhythmic drugs antimicrobial drugs antipsychotic drugs so antiarismic drugs include quinidine procainamide disoparamide antimicrobial drugs include macrolide erythromycin Clarithromycin antipsychortics include pinothiazines neuroleptics thyroidism chlorpromazine haloperidol so these are the drugs that can cause dorsard's D points now let's look at some ECGs now if you look at this ECG this is a ECG showing towards starts the point twisting around the points these are the pointed end and these are the round end that is the twisting around the points now if you calculate the heart rate the atrial rate we cannot calculate a little bit because you cannot see the p waves we can calculate the ventricular rate but in this ventricular rate can be calculated by 6 second method in six second method I have already talked about how to calculate heart rate by 6 second method in detail in my video on Rhythm determination in six second method what you do is that you actually count 30 large boxes and within those 30 large boxes you count the number of QRS complexes present and then you multiply the number of QRS complexes present in those 30 boxes with n so that is the heart rate now since we have short strip so we will take 15 large boxes and then we'll multiply the 15 large boxes by 2 so that will give us the number of QRS complexes present in 30 large boxes and now if this is uh I have already marked 15 large boxes we have one two three four five six seven eight nine ten eleven twelve thirteen fourteen fifteen in these 15 large boxes we have one two three four five six seven eight nine ten eleven twelve almost thirteen thirteen QRS complexes Within These 15 large boxes and in 30 then we will have 26 the double of 13. 26 QRS complexes in 30 large boxes now we'll have to multiply the answer by 10 26 multiply by 10 is 260 period per minute so the ventricular rate is 260 beat per minute regularity is irregular the p waves are absent PR interval there is no P wave there is no PR interval the QRS complex determining the size of QRS complex in uh tors swords is very difficult we don't know where the QRS complex is starting where it is ending so we can just simply say that the QRS complex is wide the interpretation is that this ECG is of torsards now if you look at this ECG in this ccg these are the pointed ends and these are the rounded ends over here these are the pointed ends these are the rounded ends so this is the twisting of the points torsards now if you calculate the heart rate the atrial rate we are unable to determine you calculate the ventricular rate by same six second method in which you calculate the number of QRS complexes in 30 large boxes then you multiply it but and I have already calculated it the rate is 180 bits per minute the regularity is irregular p waves are absent PR interval there is no PR interval we have no p waves QRS complex is wide the interpretation is tors starts this is another ECG these are the pointed ends these are the round ends so this is the ECG of torsards the atrial rate we are unable to determine we have no p waves ventricular rate is 250 beats per minute counted by the six second method the p waves are absent PR interval is none QRS complex is wide the interpretation is dorsards the points now coming to the management of towards are the points remember the management of torsar's reports is very simple if the patient is unstable patient is developing hypotension and the patient is losing pulses you have to shock the patient it is that ventricular tachycardia and remember ventricular tachycardias are shockable Rhythm so you shock the patient if the patient is stable if the patient is not having hypotension or if the patient is not losing pulses in such case you can give IV magnesium mean treatment remember if someone asks you the treatment of torsards that is IV magnesium magnesium sulfate is given 8 millimole over 15 minutes then 72 millimole over 24 hours you avoid amidoron procainamide suitalol in these because as these drugs can cause stories even they can worsen torsoids you treat the underlying cause you correct the electrolytes you stop the causative drugs and you treat the hypothyroidism so this is the management of torsars remember IV magnesium sulphate as the main treatment of tarsads before going into the summary if you liked my video please click on the Subscribe button in this video we talked about what is ventricular Rhythm what is monomorphic ventricular tachycardia and how multiple Focus if they combine together they form a polymorphic ventricular tachycardia what is tors Stars the points and how does it present and the management of torsar Z points if you liked my video please click on the Subscribe button and check out my other videos on ECG interpretation lectures the link of those videos are given in the description below thank you very much