Paroxysmal supraventricular tachycardia

Diagnosis

Sx	Sinus Tach	SVT
Hx	volume loss	sudden onset
PE	dehydated	CHF-like
*HR	<180	>180
Variability	Yes	No

*In infants HR cuttoff = 220

Treatment

1. Unstable
   1. Synchronized cardioversion 0.5-1.0 J/kg
2. Stable
   1. Vagal maneuvers
   2. Adenosine
      1. 6mg IVP; 12mg IVP (if initial dose failed)
   3. Calcium-Channel Blockers
      1. Diltiazem 15–20mg IV over 2min
         1. May give 25mg IV if inadequate response after 15min
         2. If IV bolus worked start IV infusion at 5–20mg/hr
         3. Contraindications: Hypotension, CHF
      2. Beta-Blockers
         1. Metoprolol 5mg IV q5min x 3; give 50mg PO if IVP effective
         2. Esmolol 500mcg/kg IV over 60sec
            1. May give repeat bolus if inadequate response after 2-5min
            2. If effective start infusion at 50mcg/kg/min (titrate up to 300mcg/kg/min)

See Also

1. V Tach vs. SVT
2. Tachycardia (Narrow)
3. ACLS (Main)

Source

2/23/06 DONALDSON (adapted from Rosen), UpToDate