MyCpdZw - Protocols Details

SUPRAVENTRICULAR TACHYCARDIA

Supraventricular tachycardia (SVT), also called paroxysmal supraventricular tachycardia, is defined as an abnormally fast heartbeat. It is a broad term that includes many forms of heart rhythm problems (heart Arrhythmia) that originate above the ventricles (supraventricular) in the atria or AV(atrioventricular) node.

Diagnosis

Rate is usually 150-180 bpm and is regular narrow complex.

ST depression during supraventricular tachycardia is common & poorly predictive of ischaemic heart disease.

Not usually associated with haemodynamic instability.

Precipitated by alcohol, caffeine, stimulants, ischaemia, hypokalaemia, pregnancy and cannabis.

Management

Confirm diagnosis with ECG( echocardiogram)
Involve Medical Officer early,
ABC’s and resuscitation (usually stable),
Continuous monitoring,
IV access,
Consider Full blood count, Urea and Electrolytes, Thyroid function tests
If hypotensive revert with urgent Direct Current (DC) cardioverion after sedation (can try Adenosine quickly if not severely shocked),
Try vagal maneuvers (carotid sinus massage, valsalva maneuvers etc),
Adenosine 3 mg boluses IV. Warn patients of flushing, chest discomfort and dyspnoea. Consider pretreatment with Midazolam (Contraindicated in asthma)
Repeat every 1-2 minutes using 6 mg then 12 mg and 12 mg again,
If above fails try Verapanil IV 1 mg/min up to a max of 10 mg. pretreatment with 5 mLs Calcium Gluconate 10% minimizes hypotensive effects. Beware of asystole (DON’T use if on Beta blockers or Digoxin),
Consider use of Beta-blocker or Digoxin as alternative or anti-arrythmics like procainamide, Amiodarone or Flecanide,
After reversion always repeat ECG to check for Wolf Parkinson White syndrome,
Consider discharge on Metoprolol,
AVOID Adenosine and AV Node blocking agents (Verapamil, Beta-blockers, Digoxin) in Wolf Parkinson White with anti-dromic (ie wide complex) conduction,
AVOID Verapamil in children < 2 years,
In Left Ventricular Failure AVOID Verapamil, Beta-blockers, Flecanide or Procainamide.

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