SVT

Question 1

Symptoms of SVT

Answer 1

Palpitations

Question 2

ECG of SVT

Answer 2

The ECG shows a regular, rapid, narrow complex tachycardia.

Question 3

If there are no p waves, what differentials does it include?

Answer 3

atrioventricular nodal reentry (AVNRT) or atrioventricular reciprocating tachycardia (AVRT)

Question 4

This is therefore a supraventricular tachycardia. There are no discernible P waves and therefore the differential diagnosis includes associated with an accessory pathway.

The lack of P waves excludes sinus tachycardia and atrial flutter (no flutter waves). It is not broad complex (excluding VT) and is not irregular (excluding AF).

Answer 4

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Question 5

What is a carotid sinus massage?

Answer 5

gently massaging the carotid artery for 5 seconds on one side of your neck whilst monitoring your heart rhythm and blood pressure.

Question 6

What is the valsava manouvre?

Answer 6

breathe out strongly through your mouth while holding your nose tightly closed. This creates a forceful strain that can trigger your heart to react and go back into normal rhythm.

Question 7

What things might patient try to stop palpitations and why do these work?

Answer 7

Sticking his fingers down his throat,
Dipping his face in ice cold water (diving reflex)
Pressing hard on his eyeballs
Swallowing crushed ice/cold drink

Stimulates vagus nerve (PNS) and distracts heart, thereby stopping the reentry rhythm