Approach to supraventricular tachycardia
Approach to supraventricular tachycardia Supraventricular tachycardia (SVT) is a rapid heart rhythm originating above the ventricles, often causing palpitations, dizziness, or even fainting. Managing SVT requires a systematic approach that includes acute management, diagnosis, and long-term treatment strategies. Understanding this approach is essential for healthcare professionals to effectively stabilize patients and prevent recurrent episodes.
Approach to supraventricular tachycardia When a patient presents with symptoms suggestive of SVT, initial assessment focuses on hemodynamic stability. If the patient is unstable—evidenced by hypotension, chest pain, or altered mental status—immediate synchronized electrical cardioversion is indicated. This intervention is often lifesaving and takes precedence over other measures. For stable patients, the primary goal is to terminate the arrhythmia with vagal maneuvers, such as the Valsalva maneuver or carotid sinus massage, which increase parasympathetic tone and can interrupt the reentrant circuit responsible for SVT.
If vagal maneuvers fail, intravenous medications are employed. Adenosine is the first-line drug due to its rapid onset and high efficacy in terminating reentrant SVT. Administered as a rapid bolus, typically 6 mg, it often restores sinus rhythm within seconds. If ineffective, a second dose of 12 mg may be given. Alternative agents include calcium channel blockers like diltiazem or verapamil, and occasionally beta-blockers, especially in patients with contraindications to adenosine. Approach to supraventricular tachycardia
Once the acute episode is controlled, the next step involves diagnosis. An electrocardiogram (ECG) obtained during or immediately after the episode can provide clues to the specific type of SVT. Features such as narrow QRS complexes and the absence of visible P waves, or the presence of retrograde P waves, help differentiate types like atrioventricular reentrant tachycardia (AVRT) or atrioventricular nodal reentrant tachycardia (AVNRT). Sometimes, a longer-term monitoring device like a Holter monitor or an event recorder is necessary to capture intermittent episodes for detailed analysis.
Approach to supraventricular tachycardia Long-term management focuses on preventing recurrence. This involves a combination of lifestyle modifications, pharmacotherapy, and in some cases, catheter ablation. Patients are advised to avoid triggers such as caffeine, alcohol, and stress. Pharmacological options include beta-blockers and calcium channel blockers, which reduce the frequency of episodes. However, catheter ablation of the reentrant pathway has become the definitive treatment, offering a high success rate and cure, especially in patients with recurrent, symptomatic SVT.
Approach to supraventricular tachycardia In some cases, identifying and addressing underlying structural heart disease or other risk factors is essential. Patient education about recognizing symptoms and seeking prompt medical attention is equally important. Regular follow-up ensures optimal management and reassessment of therapy effectiveness.
In summary, the approach to SVT begins with prompt assessment and stabilization, followed by targeted pharmacologic and non-pharmacologic treatments to terminate episodes. Long-term strategies aim to prevent recurrence and improve quality of life, with catheter ablation playing a pivotal role in definitive cure for suitable candidates. Approach to supraventricular tachycardia
