Drug of choice for paroxysmal supraventricular tachycardia
Drug of choice for paroxysmal supraventricular tachycardia Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmia characterized by sudden episodes of rapid heart rate originating above the ventricles. These episodes can be distressing and sometimes alarming for patients, but with appropriate management, they are often effectively controlled or terminated. Understanding the pharmacological options available is essential for clinicians and patients alike, especially regarding the drug of choice for acute episodes.
In the acute setting, the primary goal is to rapidly terminate the tachycardia to alleviate symptoms and prevent potential hemodynamic compromise. Several medications are considered first-line, with intravenous adenosine recognized as the drug of choice due to its rapid action and high efficacy. Adenosine works by transiently blocking the atrioventricular (AV) node, which is often the critical pathway in reentrant circuits causing PSVT. Its quick onset, typically within seconds, and short half-life—less than 10 seconds—allow for rapid diagnosis and termination of the arrhythmia with minimal side effects.
Administering adenosine involves a rapid intravenous push followed by a saline flush. Patients often experience a brief period of flushing, chest discomfort, or a sense of impending doom, but these are transient. The effectiveness of adenosine in converting PSVT to sinus rhythm is high, with success rates exceeding 90% in many cases. Its safety profile and efficacy make it the first-line agent in emergency settings. Drug of choice for paroxysmal supraventricular tachycardia
If adenosine is contraindicated, ineffective, or unavailable, other medications may be employed. Calcium channel blockers, such as verapamil and diltiazem, are effective in slowing AV nodal conduction and terminating PSVT. They are especially useful in patients with frequent episodes or those who cannot tolerate adenosine. These agents are administered intravenously and require careful monitoring because they can cause hypotension and bradycardia.
Beta-blockers, like metoprolol, also serve as effective options, particularly in preventing recurrence rather than acute termination. For ongoing management and prevention of episodes, oral medications such as beta-blockers and calcium channel blockers are commonly prescribed. In some cases, antiarrhythmic drugs like flecainide or propafenone may be used for rhythm control, especially in patients with recurrent episodes despite medication. Drug of choice for paroxysmal supraventricular tachycardia
Electrical cardioversion is reserved for unstable patients presenting with severe symptoms or hemodynamic instability, where drug therapy may not be sufficient or rapid stabilization is necessary. It involves delivering a synchronized electric shock to restore normal rhythm and is highly effective. Drug of choice for paroxysmal supraventricular tachycardia
Drug of choice for paroxysmal supraventricular tachycardia Overall, adenosine remains the cornerstone for acute termination of PSVT due to its rapid action, high efficacy, and safety profile. However, selecting the appropriate drug involves considering patient-specific factors, contraindications, and the clinical context. Long-term management often incorporates medications to prevent recurrence, alongside lifestyle modifications and, in some cases, catheter ablation, which offers a potential cure.
In summary, for immediate intervention, adenosine is widely regarded as the drug of choice for paroxysmal supraventricular tachycardia. Its ability to swiftly terminate episodes and facilitate diagnosis makes it an invaluable tool in emergency cardiology. Drug of choice for paroxysmal supraventricular tachycardia
