What combination is recommended for polymorphic VT (Torsades)?

• A. Amiodarone and pacing
• B. Lidocaine and defibrillation
• C. Magnesium sulfate and defibrillation
• D. Adenosine and cardioversion

Answer: (C)

Torsades de pointes is a polymorphic ventricular tachycardia driven by QT prolongation and early afterdepolarizations. The most specific and effective treatment is magnesium sulfate because it stabilizes the cardiac membranes and suppresses the triggering afterdepolarizations, reducing the tendency for the rhythm to degenerate. If the patient is unstable or pulseless, immediate defibrillation is required to terminate the lethal rhythm and restore a perfusing heartbeat. Using both approaches addresses both the underlying electrical instability (magnesium) and the urgent need to reset the rhythm (defibrillation). Other options aren’t as appropriate for torsades: amiodarone can prolong the QT interval and may worsen torsades; lidocaine doesn’t target the mechanism; adenosine is for certain supraventricular tachycardias; pacing may help in bradycardia-induced torsades but isn’t the primary combined therapy here.