paroxysmal supraventricular tachycardia

Question 1

What is it?

Answer 1

Regular but rapid heart beat
Starts and stops spontaneously

Question 2

Is the heart beat regular or irregular

Answer 2

Regular

Question 3

if it does not terminate spontaneously, try the following

Answer 3

1. reflex vagal nerve stimulation under ECG monitoring (e.g. valsalva manouvre, carotid sinus massage, immerse face in ice cold water)
2. if ineffective or transient, or arrhythmia causing severe symptoms give IV adenosine
3. if ineffective or CI, give IV verapamil but avoid in pt recently treated with BB

Question 4

if you have failed to terminate PSVT with reflex vagal stimulation or drug treatment, this can suggest…

Answer 4

arrhtyhmia of atrial origin e.g. focal atrial tachycardia or atrial flutter

Question 5

treatment of haemodynamically unstable patients, or when reflex vagal nerve stimulation and drug treatment have failed to restore sinus rhythm and alternative diagnosis not found

Answer 5

direct current cardioversion

Question 6

how to prevent recurrent episodes of PSVT

Answer 6

RLCCB, BB including sotalol, flecainide, propafenone

Question 7

how to treat recurrent episodes of PSVT

Answer 7

catheter ablation