Paroxysmal supraventricular tachycardia: Difference between revisions
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''SVT terminology can be confusing, as some references consider SVT to be any rhythm originating above the ventricles (i.e. sinus tachycardia, MAT, atrial flutter, atrial fibrillation, PSVT, etc). As these entities have their own specific articles and treatment, only paroxysmal supraventricular tachycardia links here | ''SVT terminology can be confusing, as some references consider SVT to be any rhythm originating above the ventricles (i.e. sinus tachycardia, MAT, atrial flutter, atrial fibrillation, PSVT, etc). As these entities have their own specific articles and treatment, only paroxysmal supraventricular tachycardia links here. | ||
==Background== | ==Background== | ||
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{| border="1" | {| border="1" | ||
| ''' | | '''Symptoms''' | ||
| '''Sinus | | '''[[Sinus tachycardia]]''' | ||
| '''SVT''' | | '''SVT''' | ||
|- | |- | ||
| | | History | ||
| volume loss | | volume loss | ||
| sudden onset | | sudden onset | ||
|- | |- | ||
| | | Physical Exam | ||
| dehydated | | dehydated | ||
| CHF-like | | CHF-like | ||
|- | |- | ||
| | | ^Heart Rate | ||
| <180 | | <180 | ||
| >180 | | >180 | ||
| Line 31: | Line 31: | ||
|} | |} | ||
^In infants HR cuttoff = 220 | |||
== | ==Differential Diagnosis== | ||
*[[WPW]] | |||
*[[Lown-Ganong-Levine Syndrome]] | |||
*Mitral disease | |||
*[[Digitalis toxicity]] | |||
*[[Acute MI]] | |||
*[[Pericarditis]] | |||
*[[Hyperthyroidism]] | |||
*[[Drugs]] (alcohol, tobacco, caffeine) | |||
==Treatment== | ==Treatment== | ||
#Unstable | #Unstable | ||
# | #*[[Synchronized cardioversion]] 0.5-1.0 J/kg | ||
# | #*Pediatrics: cardioversion at 0.5-1 J/kg. If unsuccessful, increase to 2 J/kg | ||
#Stable | #Stable | ||
# | #*[[Vagal maneuvers]] | ||
# | #**Pediatrics: often successful with ice application to face | ||
# | #**Carotid sinus massage (ideal duration of 15 seconds<ref>Appelboam, A, et al. Randomised Evaluation of modified Valsalva Effectiveness in Re-entrant Tachycardias (REVERT) study. BMJ, 2014; 4(3):e004525.</ref>) | ||
# | #***Auscultate to r/o bruits in carotid artery before performing | ||
# | #***Perform ONE side at a time | ||
# | #**Valsalva manoeuvre (ideal duration of 10 seconds) | ||
# | #*[[Adenosine]] | ||
# | #**6mg IVP; 12mg IVP (if initial dose failed) | ||
# | #*[[Calcium-channel blockers]] | ||
# | #**[[Diltiazem]] 15–20mg IV over 2min | ||
# | #***May give 25mg IV if inadequate response after 15min | ||
# | #***If IV bolus worked start IV infusion at 5–20mg/hr | ||
# | #***Contraindications: Hypotension, CHF, any suspicion of VT | ||
# | #**Beta-blockers | ||
# | #***[[Metoprolol]] 5mg IV q5min x 3; give 50mg PO if IVP effective | ||
# | #***[[Esmolol]] 500mcg/kg IV over 60sec | ||
# | #****May give repeat bolus if inadequate response after 2-5min | ||
# | #****If effective start infusion at 50mcg/kg/min (titrate up to 300mcg/kg/min) | ||
# | #***Contraindications: asthmatics | ||
==See Also== | ==See Also== | ||
| Line 75: | Line 75: | ||
==Source== | ==Source== | ||
<references/> | <references/> | ||
[[Category:Cards]] | [[Category:Cards]] | ||
Revision as of 20:40, 3 March 2015
SVT terminology can be confusing, as some references consider SVT to be any rhythm originating above the ventricles (i.e. sinus tachycardia, MAT, atrial flutter, atrial fibrillation, PSVT, etc). As these entities have their own specific articles and treatment, only paroxysmal supraventricular tachycardia links here.
Background
- Also known as PSVT and frequently referred to just as SVT
- AV nodal reentrant tachycardia (AVNRT) and AV reentrant tachycardia (AVRT) are subtypes of PSVT
- most common dysrhythmia in children
- infants: poor feeding, tachypnea, and irritability
Diagnosis
| Symptoms | Sinus tachycardia | SVT |
| History | volume loss | sudden onset |
| Physical Exam | dehydated | CHF-like |
| ^Heart Rate | <180 | >180 |
| Variability | Yes | No |
^In infants HR cuttoff = 220
Differential Diagnosis
- WPW
- Lown-Ganong-Levine Syndrome
- Mitral disease
- Digitalis toxicity
- Acute MI
- Pericarditis
- Hyperthyroidism
- Drugs (alcohol, tobacco, caffeine)
Treatment
- Unstable
- Synchronized cardioversion 0.5-1.0 J/kg
- Pediatrics: cardioversion at 0.5-1 J/kg. If unsuccessful, increase to 2 J/kg
- Stable
- Vagal maneuvers
- Pediatrics: often successful with ice application to face
- Carotid sinus massage (ideal duration of 15 seconds[1])
- Auscultate to r/o bruits in carotid artery before performing
- Perform ONE side at a time
- Valsalva manoeuvre (ideal duration of 10 seconds)
- Adenosine
- 6mg IVP; 12mg IVP (if initial dose failed)
- Calcium-channel blockers
- Diltiazem 15–20mg IV over 2min
- May give 25mg IV if inadequate response after 15min
- If IV bolus worked start IV infusion at 5–20mg/hr
- Contraindications: Hypotension, CHF, any suspicion of VT
- Beta-blockers
- Metoprolol 5mg IV q5min x 3; give 50mg PO if IVP effective
- Esmolol 500mcg/kg IV over 60sec
- May give repeat bolus if inadequate response after 2-5min
- If effective start infusion at 50mcg/kg/min (titrate up to 300mcg/kg/min)
- Contraindications: asthmatics
- Diltiazem 15–20mg IV over 2min
- Vagal maneuvers
See Also
Source
- ↑ Appelboam, A, et al. Randomised Evaluation of modified Valsalva Effectiveness in Re-entrant Tachycardias (REVERT) study. BMJ, 2014; 4(3):e004525.