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supraventricular tachycardia (SVT)

For ACLS protocols, see tachycardia. Etiology: - hyperthyroidism - myocarditis - infection - anemia Clinical manifestations: - palpitations - neck pulsations caused by simultaneous contraction of the atria & ventricles may be described as neck fullness Laboratory: - thyroid function tests - complete blood count (CBC) a) look for leukocytosis (infection) b) look for anemia - markers of myocardial infarction may be elevated with myocarditis a) troponin-I b) CK-MB Special laboratory: - electrocardiogram a) narrow QRS complex b) a short R-P or P wave within ST segments suggests re-entry with - anterograde conduction through AV node - retrograde conduction through bypass tract c) P wave after T wave: no accessory conduction d) no P wave: - paroxysmal AV nodal re-entrant tachycardia (AVNRT) most common - short PR interval may bury p-wave in QRS complex [2] - re-entry simultaneously activates atria & ventricles [2] - may be wide complex tachycardia - look for delta wave [2] - event recorder better than HOLTER for stable patients with paroxysmal supraventricular tachycardia (PSVT) Management: - for ACLS protocols, see tachycardia - see paroxysmal supraventricular tachycardia (PSVT) - synchronized direct-current cardioversion for unstable SVT - vagal maneuvers may restore sinus rhythm - IV adenosine if not responsive to vagal maneuvers - use reduced dose in patients with a history of cardiac transplantation - recurrent supraventricular tachycardia is treated by blocking AV node - beta-blocker - non-dihydropyridine calcium channel blocker (diltiazem, verapamil) - catheter ablation

Related

atrial fibrillation (AF) atrial flutter Wolff-Parkinson-White (WPW) syndrome

Specific

atrial tachycardia AV junctional tachycardia AV nodal re-entrant tachycardia (AVNRT) orthodromic AV reciprocating tachycardia paroxysmal supraventricular tachycardia (PSVT) sinus tachycardia

General

supraventricular arrhythmia narrow complex tachycardia

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 105,182
  2. Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2012, 2015, 2018, 2022. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Colucci RA, Silver MJ, Shubrook J. Common types of supraventricular tachycardia: diagnosis and management. Am Fam Physician. 2010 Oct 15;82(8):942-52. PMID: 20949888
  4. Fox DJ, Tischenko A, Krahn AD et al Supraventricular tachycardia: diagnosis and management. Mayo Clin Proc. 2008 Dec;83(12):1400-11 PMID: 19046562
  5. Link MS Clinical practice. Evaluation and initial treatment of supraventricular tachycardia. N Engl J Med. 2012 Oct 11;367(15):1438-48 PMID: 23050527
  6. Delacretaz E Clinical practice. Supraventricular tachycardia. N Engl J Med. 2006 Mar 9;354(10):1039-51. PMID: 16525141
  7. 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. J Am Coll Cardiol. 2016 Apr 5;67(13):e27-e115. PMID: 26409259 Free Article
  8. 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. Circulation. 2016 Apr 5;133(14):e506-7 PMID: 26399663
  9. Kotadia ID, Williams SE, O'Neill M Supraventricular tachycardia: An overview of diagnosis and management. Clin Med (Lond). 2020 Jan;20(1):43-47 PMID: 31941731 PMCID: PMC6964177Free PMC article
  10. Link MS. Clinical practice. Evaluation and initial treatment of supraventricular tachycardia. N Engl J Med. 2012 Oct 11;367(15):1438-48 PMID: 23050527 Review. https://www.nejm.org/doi/pdf/10.1056/NEJMcp1111259