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Cardiology > Supraventricular tachycardia > Flashcards

Supraventricular tachycardia Flashcards

1
Q

Define supraventricular tachycardia

A

Regular narrow-complex tachycardia (>100 bpm) w/ no p waves & a supraventricular origin

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2
Q

Supraventricular tachycardia generally refers to:

2 + other that is SVT

A

atrioventricular nodal re-entry tachycardia (AVNRT)
atrioventricular re-entry tachycardia (AVRT)

AF technically is a type of SVT

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3
Q

Aetiology of supraventricular tachycardia

2

A

AVNRT - a localised re-entry circuit forms around the AV node

AVRT - a re-entry circuit forms between the atria & ventricles due to presence of accessory pathway (Bundle of Kent)

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4
Q

Risk factors for supraventricular tachycardia

5

A 
Nicotine
Alcohol
Caffeine
Previous MI
Digoxin toxicity
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5
Q

Epidemiology of supraventricular tachycardia

prevalence, gender

A

VERY COMMON

2x more common in females

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6
Q

Presenting symptoms of supraventricular tachycardia

6

A

May have minimal symptoms or may present w/ syncope
Symptoms vary depending on rate & duration of SVT
Palpitations
Light headedness
Abrupt onset & termination of symptoms
Other: fatigue, chest discomfort, dyspnoea, syncope

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7
Q

Signs of supraventricular tachycardia on physical examination
(1 +2)

A

AVNRT
Normal except tachycardia

Wolff-Parkinson-White syndrome
Tachycardia
Secondary cardiomyopathy (S3 gallop, RV heave, displaced apex beat)

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8
Q

Investigations for supraventricular tachycardia

6 types

A 
ECG
Cardiac enzymes
Electrolytes
TFTs
Digoxin level
Echocardiogram
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9
Q

Investigations for supraventricular tachycardia - ECG

2

A

Once SVT has been terminated & normal rate & rhythm are re-established:

  • AVNRT: appears normal
  • AVRT: delta waves (slurred upstroke of QRS complex)

24hr ECG monitoring - required in patients w/ paroxysmal palpitations

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10
Q

Investigations for supraventricular tachycardia - cardiac enzymes

A

Check for features of MI (especially if there’s chest pain)

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11
Q

Investigations for supraventricular tachycardia - electrolytes

A

Can cause arrhythmias

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12
Q

Investigations for supraventricular tachycardia - TFTs

A

Can cause arrhythmias

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13
Q

Investigations for supraventricular tachycardia - digoxin level

A

For patients on digoxin

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14
Q

Investigations for supraventricular tachycardia - echocardiogram

A

Check structural heart disease

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15
Q

Management of supraventricular tachycardia

4 divisions

A

Haemodynamically UNSTABLE

Haemodynamically STABLE

Unresponsive to chemical cardioversion OR tachycardia >250 bpm OR adverse signs

Ongoing management

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16
Q

Management of supraventricular tachycardia - haemodynamically unstable

A

DC cardioversion

17
Q

Management of supraventricular tachycardia - haemodynamically stable
(1 + 3)

A

(vagal manoeuvres + chemical cardioversion)

Vagal manœuvres (e.g. Valsalva, carotid massage)
- Carotid massage can dislodge atherosclerotic plaques so only performed in younger patients

If they fail:
Adenosine 6mg bolus (can increase to 12mg)
- contraindicated in ASTHMA as it can cause bronchospasm
Can give verapamil 2.5-5mg if unsuccessful or contraindicated
Alternatives: atenolol, amiodarone

18
Q

Management of supraventricular tachycardia - unresponsive to chemical cardioversion OR tachycardia >250 bpm OR adverse signs
(2)

A

Sedate & synchronised DC cardioversion

Amiodarone

19
Q

Management of supraventricular tachycardia - ongoing

3 AVNRT, AVRT, 2 sinus tachycardia

A

AVNRT
Radiofrequency ablation of slow pathway
β-blockers
Alternatives: flueicanide, propafenone, verapamil

AVRT
Radiofrequency ablation

Sinus tachycardia
Exclude 2º cause (e.g. hyperthyroidism)
β-blockers or rate limiting CCB

20
Q

Complications of supraventricular tachycardia

4

A

Haemodynamic collapse
DVT
Systemic embolism
Cardiac tamponade

21
Q

Prognosis of supraventricular tachycardia

3

A

Dependent on presence of underlying structural heart disease
If structurally normal heart - GOOD prognosis
People w/ pre-excitation have small risk of sudden death

Cardiology (31 decks)

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