The supraventricular tachycardia pals svt algorithm
The supraventricular tachycardia pals svt algorithm Supraventricular Tachycardia (SVT) is a common cardiac arrhythmia characterized by a rapid heart rate originating above the ventricles. It can cause symptoms such as palpitations, dizziness, shortness of breath, and in severe cases, chest discomfort or fainting. Due to its unpredictable nature, effective management hinges on accurate diagnosis and swift intervention. The SVT algorithm serves as a clinical decision-making tool that guides healthcare providers through an evidence-based approach to diagnosing and treating SVT efficiently.
The initial step in the SVT algorithm involves the assessment of the patient’s hemodynamic stability. If a patient presents with signs of instability—such as hypotension, chest pain, altered mental status, or signs of shock—immediate synchronized electrical cardioversion is indicated. This emergency intervention can rapidly restore normal rhythm and is vital in life-threatening situations. For stable patients, the focus shifts to pharmacological and non-pharmacological management.
In stable patients, the algorithm recommends performing a careful history and physical examination, followed by an electrocardiogram (ECG). The ECG is crucial in confirming the diagnosis and identifying specific features of SVT, such as narrow QRS complexes, absence of visible P waves, or retrograde P waves. Once SVT is confirmed, vagal maneuvers are the first-line non-invasive interventions. Techniques like the carotid sinus massage or the Valsalva maneuver stimulate the vagus nerve, aiming to slow conduction through the atrioventricular (AV) node and potentially terminate the tachycardia. The supraventricular tachycardia pals svt algorithm
If vagal maneuvers are unsuccessful, the next step involves administering pharmacologic agents. Intravenous adenosine is the preferred drug due to its rapid onset and high efficacy in terminating AV nodal reentrant tachycardia (AVNRT), the most common form of SVT. Adenosine acts by transiently blocking conduction through the AV node. Its administration should be done with continuous ECG and vital sign monitoring, and with preparedness for a brief period of asystole or flushing, which are common side effects. The supraventricular tachycardia pals svt algorithm
The supraventricular tachycardia pals svt algorithm Should adenosine prove ineffective, alternative medications like calcium channel blockers (e.g., diltiazem or verapamil) or beta-blockers can be employed to further slow conduction through the AV node. Persistent or recurrent SVT episodes may warrant further evaluation, including electrophysiological studies, to identify the specific arrhythmogenic substrate and consider catheter ablation therapy.
In cases where pharmacologic therapy fails or is contraindicated, synchronized electrical cardioversion remains an essential option, especially if the patient becomes unstable. Post-conversion, appropriate medications or interventions are implemented to prevent recurrence, and patients are often referred for outpatient management, including potential ablation procedures. The supraventricular tachycardia pals svt algorithm
The supraventricular tachycardia pals svt algorithm Overall, the SVT algorithm emphasizes a systematic approach—prioritizing patient stability, confirming diagnosis with ECG, employing vagal and pharmacologic maneuvers, and resorting to electrical cardioversion when necessary. Familiarity with this algorithm allows clinicians to provide prompt, effective care, reducing morbidity and improving patient outcomes.
