Management of SVT

Question 1

Junctional tachycardia

Answer 1

• difficult to treat
• verapamil, B-clockers, felecainide
• ablation in slow pathway with caution as you can produce heart block

Question 2

Inappropriate sinus tachycardia

Answer 2

• usually young women
• B-blockers
• ivabradine, slows sinus node & nothing else, available in Europe & Canada

Question 3

Treatment options: maneuvers

Answer 3

• valsalva, cough, carotid sinus massage, ice water

Question 4

Treatment options: drugs

Answer 4

• adenosine (given rapidly will block AV node, very short acting so must give as a bolus)
• verapamil, diltiazem, metoprolol, amiodarone, procainamide, ibutilide

Question 5

Treatment options: cardioversion

Answer 5

cardioversion

Question 6

Multifocal atrial tachycardia

Answer 6

• associated w/ acute illness, usually pulmonary, occaisonally abdominal
• treat w/ VERAPAMIL

Question 7

Caveats

Answer 7

• rate is 150/min = ATRIAL FLUTTER until proven otherwise
• ECGs are taken at rest in supine position where tachycardia isn’t physiologic
• Look for P waves

Question 8

Atrial Fibrillation concerns

Answer 8

• symptoms
• stroke
• long term damage: tachycardia mediated cardiomyopathy

Question 9

AFib management

Answer 9

• if > 24 hrs: anticoagulate, start warfarin, dabigitran, rivaroxaban, apixaban, lovenox 15 mg/kg daily – INR >2 for 3-4 wks
• if

Question 10

Therapies for Afib

Answer 10

• rate control & warfarin (AFFIRM)
• rhythm control agents and cardioversions
• Afib ablation, pulmonary vein isolation
• pacing w/ or w/out AV nodal ablation
• surgical options

Question 11

Atrial tachycardia

Answer 11

• automatic: most common in children & post menopausal women
• re-entrant