Fique off-line com o app Player FM !
Episode 926: Supraventricular Tachycardia
Fetch error
Hmmm there seems to be a problem fetching this series right now. Last successful fetch was on October 21, 2024 12:02 ()
What now? This series will be checked again in the next day. If you believe it should be working, please verify the publisher's feed link below is valid and includes actual episode links. You can contact support to request the feed be immediately fetched.
Manage episode 446177488 series 1397179
Contributor: Taylor Lynch MD
Supraventricular tachycardias (SVTs) arise above the bundle of His
The term SVT includes AV nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial tachycardia, atrial fibrillation, atrial flutter, and multifocal atrial tachycardia
AVNRT is the most common form of SVT
Paroxysmal
Spontaneous or provoked by exertion, coffee, alcohol, or thyroid disease
More common in women (3:1 women:men ratio)
HR 160-240
Narrow complex with a normal QRS
Unstable patients receive synchronized cardioversion at 0.5-1 J/kg
Valsalva maneuver is attempted before pharmaceutical interventions
Increases vagal tone at the AV node to slow conduction and prolongs its refractory period to normalize the conduction
Traditionally, patients are asked to bear down, but this only works in 17% of patients
REVERT trial assessed a modified valsalva that worked in 43% of patients
Adenosine
Slows conduction at the AV node by activating potassium channels and inhibiting calcium influx
Extremely uncomfortable for most patients
Not commonly used anymore
Nondihydropyridine calcium-channel blockers are preferred
A 2009 RCT investigated low-infusion CCBs compared with adenosine bolus
The study found a conversion rate of 98% in the CCB group vs. adenosine group at 86.5%
The main adverse effect of CCB is hypotension, which a slow infusion rate can mitigate
Diltiazem dose is 0.25 mg/kg/2min and repeat at 0.35 mg/kg/15 minutes or slow infusion at 2.5 mg/min up to a conversion or 50 mg total
References
1. Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): A randomised controlled trial. Lancet. 2015;386(10005):1747-1753. doi:10.1016/S0140-6736(15)61485-4
Belz MK, Stambler BS, Wood MA, Pherson C, Ellenbogen KA. Effects of enhanced parasympathetic tone on atrioventricular nodal conduction during atrioventricular nodal reentrant tachycardia. Am J Cardiol. 1997;80(7):878-882. doi:10.1016/s0002-9149(97)00539-0
Lim SH, Anantharaman V, Teo WS, Chan YH. Slow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia. Resuscitation. 2009;80(5):523-528. doi:10.1016/j.resuscitation.2009.01.017
Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society [published correction appears in Circulation. 2016 Sep 13;134(11):e234-5. doi: 10.1161/CIR.0000000000000448]. Circulation. 2016;133(14):e506-e574. doi:10.1161/CIR.0000000000000311
Summarized & Edited by Jorge Chalit, OMS3
1077 episódios
Fetch error
Hmmm there seems to be a problem fetching this series right now. Last successful fetch was on October 21, 2024 12:02 ()
What now? This series will be checked again in the next day. If you believe it should be working, please verify the publisher's feed link below is valid and includes actual episode links. You can contact support to request the feed be immediately fetched.
Manage episode 446177488 series 1397179
Contributor: Taylor Lynch MD
Supraventricular tachycardias (SVTs) arise above the bundle of His
The term SVT includes AV nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial tachycardia, atrial fibrillation, atrial flutter, and multifocal atrial tachycardia
AVNRT is the most common form of SVT
Paroxysmal
Spontaneous or provoked by exertion, coffee, alcohol, or thyroid disease
More common in women (3:1 women:men ratio)
HR 160-240
Narrow complex with a normal QRS
Unstable patients receive synchronized cardioversion at 0.5-1 J/kg
Valsalva maneuver is attempted before pharmaceutical interventions
Increases vagal tone at the AV node to slow conduction and prolongs its refractory period to normalize the conduction
Traditionally, patients are asked to bear down, but this only works in 17% of patients
REVERT trial assessed a modified valsalva that worked in 43% of patients
Adenosine
Slows conduction at the AV node by activating potassium channels and inhibiting calcium influx
Extremely uncomfortable for most patients
Not commonly used anymore
Nondihydropyridine calcium-channel blockers are preferred
A 2009 RCT investigated low-infusion CCBs compared with adenosine bolus
The study found a conversion rate of 98% in the CCB group vs. adenosine group at 86.5%
The main adverse effect of CCB is hypotension, which a slow infusion rate can mitigate
Diltiazem dose is 0.25 mg/kg/2min and repeat at 0.35 mg/kg/15 minutes or slow infusion at 2.5 mg/min up to a conversion or 50 mg total
References
1. Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): A randomised controlled trial. Lancet. 2015;386(10005):1747-1753. doi:10.1016/S0140-6736(15)61485-4
Belz MK, Stambler BS, Wood MA, Pherson C, Ellenbogen KA. Effects of enhanced parasympathetic tone on atrioventricular nodal conduction during atrioventricular nodal reentrant tachycardia. Am J Cardiol. 1997;80(7):878-882. doi:10.1016/s0002-9149(97)00539-0
Lim SH, Anantharaman V, Teo WS, Chan YH. Slow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia. Resuscitation. 2009;80(5):523-528. doi:10.1016/j.resuscitation.2009.01.017
Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society [published correction appears in Circulation. 2016 Sep 13;134(11):e234-5. doi: 10.1161/CIR.0000000000000448]. Circulation. 2016;133(14):e506-e574. doi:10.1161/CIR.0000000000000311
Summarized & Edited by Jorge Chalit, OMS3
1077 episódios
Wszystkie odcinki
×Bem vindo ao Player FM!
O Player FM procura na web por podcasts de alta qualidade para você curtir agora mesmo. É o melhor app de podcast e funciona no Android, iPhone e web. Inscreva-se para sincronizar as assinaturas entre os dispositivos.