39 Questions
What are the three common types of paroxysmal SVT?
Atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, atrial tachycardia
What may be included in the diagnostic evaluation of paroxysmal SVT?
Comprehensive history and physical examination, electrocardiography, and laboratory workup
In which setting is the acute management of paroxysmal SVT best completed?
Emergency department or hospital setting
What is the first-line management for patients who are hemodynamically unstable with paroxysmal SVT?
Synchronized cardioversion
Which of the following symptoms may be associated with paroxysmal SVT?
Chest pressure or discomfort and palpitations
Which of the following is the most common type of paroxysmal SVT?
Atrioventricular Nodal Reentrant Tachycardia (AVNRT)
What is the first-line management for paroxysmal SVT in those who are hemodynamically stable?
Vagal maneuvers
What is a common trigger for AVNRT, especially in young people?
Hyperthyroidism
What is a highly successful method for long-term management of recurrent, symptomatic paroxysmal SVT?
Catheter ablation
What is the prevalence of paroxysmal SVT in the general population?
2.29 per 1,000 people
Which cardiac comorbidity can trigger reentrant tachycardias, especially in older patients?
Congestive heart failure
Which type of Supraventricular Tachycardia (SVT) is the second most common overall and the most common in children?
Atrioventricular Reentrant Tachycardia (AVRT)
What is the characteristic ECG feature in AVRT that can result in hidden P waves?
Simultaneous atrial and ventricular activation
What causes anterograde preexcitation identified by a short PR interval, a slurred QRS complex upstroke (delta wave), and a wide QRS complex?
Accessory pathways
Which type of Supraventricular Tachycardia (SVT) is less common than AVRT, accounting for about 10% of all SVT cases, and is often found in young adults?
Atrial Tachycardia (AT)
What condition results from an accessory pathway that conducts anterogradely, causing a delta wave and increasing the risk of arrhythmias such as atrial fibrillation and sudden cardiac death?
Wolff-Parkinson-White syndrome
In which type of Supraventricular Tachycardia (SVT) do PR intervals typically remain normal due to unchanged delay from the atrioventricular node?
Atrial Tachycardia (AT)
Which type of tachycardia can manifest with a retrograde accessory pathway and antidromic conduction, and does not require Wolff-Parkinson-White syndrome?
Atrioventricular reentrant tachycardia (AVRT)
What type of atrial tachycardia typically presents as a regular atrial rhythm with a 1:1 ratio of atrioventricular conduction and may involve a 'warm up' phenomenon?
Focal atrial tachycardia
Which type of atrial tachycardia may have a sudden onset and repetitive short bursts, due to increased automaticity?
Atrial tachycardia due to microreentry
What is an important consideration in the diagnostic evaluation of SVT in relation to postural changes?
Sinus tachycardia
What type of evaluation for SVT may involve assessing vital signs, performing focused physical examination, and inducing tachycardia to determine the underlying cause?
In-office evaluation
What is an important part of the differential diagnosis of SVT?
Atrial flutter
What is the first-line acute management approach for narrow complex paroxysmal supraventricular tachycardia (SVT)?
Synchronized cardioversion
Which medication is used in hemodynamically stable patients for terminating narrow complex SVT or as a diagnostic and therapeutic agent in wide complex tachycardia?
Adenosine
What is a part of the short-term medication management for paroxysmal SVT?
Adenosine
Which diagnostic testing is commonly included for patients with paroxysmal SVT?
Complete blood count
What is the initial acute management approach for wide complex tachycardia?
Advanced Cardiovascular Life Support pathways
What is a part of the long-term management for paroxysmal SVT?
Cardiologist referral
Which medication is a short-term treatment for paroxysmal SVT and has an indication as a sodium channel blocker?
Ibutilide
What is the class indication for verapamil in the treatment of SVT?
Class IVa
Which medication should be avoided in patients with a prolonged QT interval due to its adverse effects?
Ibutilide
In case of wide complex tachycardia, what should it be treated as until proven otherwise?
Ventricular tachycardia
Which medication is a long-term treatment used to decrease heart rate with a class IIa indication and should not be used in patients having preexcitation or with a wide QRS complex?
Metoprolol
Which medication is a long-term treatment used to prevent SVT with a class IC indication and should not be used in patients with structural or ischemic heart disease, wide QRS complex, or atrioventricular blocks?
Propafenone
What can be used as a first-line treatment for wide complex tachycardia in hemodynamically stable hospitalized patients?
Procainamide
What are the indications for cardiology referral when evaluating a patient with known or suspected paroxysmal SVT in the outpatient setting?
High-risk occupations and known structural heart disease
What can be used to distinguish between paroxysmal SVT with aberrant conduction and ventricular tachycardia?
Brugada criteria
What is the main adverse effect of diltiazem in the context of SVT treatment?
Hypotension and bradycardia
Study Notes
- Supraventricular tachycardia (SVT) is a type of heart rhythm disorder, and there are different medication management options for its treatment.
- Ibutilide is a short-term medication used to treat paroxysmal SVT in adults with a class IIIa indication. It is a potassium channel blocker that prolongs repolarization, and it has adverse effects such as proarrhythmic effects and should be avoided in patients with a prolonged QT interval.
- Diltiazem and verapamil are long-term medications used to prevent SVT, with a class IVa indication. Diltiazem is a calcium channel blocker that can cause bradycardia and conduction disturbance. Verapamil is also a calcium channel blocker that can cause hypotension and bradycardia. Both have adverse effects and should be used with caution in patients with heart failure.
- Flecainide is a short-term medication used to treat paroxysmal SVT with a class IC indication. It is a sodium channel blocker that slows conduction and has adverse effects such as proarrhythmic effects, conduction disturbance, dizziness, and visual disturbance. It should be used with caution among patients with structural or ischemic heart disease.
- Metoprolol is a long-term medication used to decrease heart rate with a class IIa indication. It comes in both immediate and extended-release forms, with different dosages and adverse effects such as bradycardia, sinus pause, and atrioventricular block. It should not be used in patients having preexcitation or with a wide QRS complex.
- Propafenone is a long-term medication used to prevent SVT with a class IC indication. It is a sodium channel blocker that slows conduction and has adverse effects such as dizziness, nausea, proarrhythmic effects, and hypotension. It should not be used in patients with structural or ischemic heart disease, wide QRS complex, or atrioventricular blocks.
- In case of a wide complex tachycardia, caution is needed, and it should be treated as ventricular tachycardia until proven otherwise. Brugada criteria can be used to distinguish between paroxysmal SVT with aberrant conduction and ventricular tachycardia. If a wide complex tachycardia is identified in hemodynamically stable hospitalized patients, intravenous procainamide can be used as a first-line treatment.
- Indications for cardiology referral include high-risk occupations, known structural heart disease, preexcitation or delta wave, and symptoms not controlled with current medication management. Cardiology referral is recommended when evaluating a patient with known or suspected paroxysmal SVT in the outpatient setting.
This quiz covers the relationship between Wolff-Parkinson-White syndrome and atrioventricular reentrant tachycardia, including the presence of delta waves and antidromic tachycardia. It delves into how the syndrome pattern influences the occurrence of atrioventricular reentrant tachycardia.
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