II. Causes: Narrow Complex Tachycardia (Mnemonic: 5H 5T P)

  1. Similar list to Reversible Causes of Cardiopulmonary Arrest (5H5T)
  2. Hypoxemia
  3. Hypovolemia
  4. Hyperthermia
  5. Hyperkalemia
  6. Hypokalemia
  7. Tamponade (Cardiac Tamponade)
  8. Tension Pneumothorax
  9. Toxins, medications and drugs
    1. Caffeine
    2. Tobacco
    3. Alcohol
    4. Pseudophedrine
  10. Thrombus
    1. Myocardial Infarction
    2. Pulmonary Embolism
  11. Pain or Stress

III. Types: Narrow Complex Tachycardia (key question is 'regular or irregular')

  1. Adults
    1. Sinus Tachycardia (regular)
    2. Irregular Supraventricular Tachycardia (may also present as wide complex if aberrancy)
      1. Atrial Fibrillation
    3. Regular Supraventricular Tachycardia
      1. Atrial Flutter
      2. Atrioventricular Nodal Reentry (AVNRT): 60% of SVT cases
      3. Atrioventricular Reciprocating Tachycardia (AVRT): 30% of SVT cases
      4. Atrial Tachycardia (AT): 10% of SVT cases
  2. Children
    1. Common
      1. Orthodromic reciprocating Tachycardia (ORT)
        1. Most common in children (typical SVT)
      2. Atrioventricular Nodal Reentry (AVNRT)
        1. Second most common SVT in children (but rare in young children)
    2. Uncommon
      1. Ectopic Atrial Tachycardia
        1. Similar to sinus rhythm except for altered P Wave appearance and more rapid rate
      2. Atrial Flutter (uncommon in children outside the newborn period)
      3. Atrial Fibrillation (very rare in children)
    3. Congenital Heart Disease history
      1. CHD predisposes patients to scarring with risk of reentrant pathways
      2. Intra-atrial reentrant Tachycardia (IART)
        1. Appears similar to Atrial Flutter
        2. Typically treated with rate control on Diltiazem (if over age 2-5 years), followed by cardioversion

IV. Symptoms

  1. Chest pressure
  2. Dyspnea
  3. Fatigue
  4. Light headed
  5. Palpitations

V. Signs

  1. Sinus Tachycardia
    1. P Waves present and normal
      1. At higher rates P Wave may be hidden in T Wave
      2. Look for high frequency notching within the T Wave to suggest a hidden P Wave
    2. Variable R-R with constant PR interval
    3. Heart Rate varies with activity
    4. Rate lower than PSVT
      1. Infants < 220 (may approach this with fever)
      2. Children < 180
      3. Adults < 160
  2. Supraventricular Tachycardia
    1. P Waves absent or abnormal
    2. Fixed Heart Rate (constant R-R)
    3. Abrupt rate change
    4. Rate higher than Sinus Tachycardia (especially if Heart Rate twice normal for age or higher)
      1. Infants > 220
      2. Children > 180
      3. Adults > 160

VI. Management: Stable Patients

  1. New emphasis on use of one Antiarrhythmic
    1. Contrast to prior Antiarrhythmic soups
    2. Pro-arrhythmic effects increase with poly-drugs
  2. Supraventricular Tachycardia Management in the Adult
  3. Supraventricular Tachycardia Management in the Child

VII. Management: Unstable Patients

Images: Related links to external sites (from Google)

Ontology: Paroxysmal supraventricular tachycardia (C0030590)

Definition (CHV) periods of very rapid heart beats that begin and end abruptly
Definition (CHV) periods of very rapid heart beats that begin and end abruptly
Definition (NCI) An episodic form of supraventricular tachycardia, with abrupt onset and termination.
Concepts Disease or Syndrome (T047)
ICD9 427.0
SnomedCT 195074009, 67198005, 155363003, 266305002
English PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA, TACHYCARDIA, PAROXYSMAL SUPRAVENTRICULAR, Paroxysm.supravent.tachyc. NOS, Paroxysmal supravent.tachycard, Paroxysmal supraventricular tachycardia NOS, PSVT, paroxysmal supraventricular tachycardia (diagnosis), psvt, paroxysmal supraventricular tachycardia, Paroxysmal tachycardia (supraventricular), SUPRAVENTRICULAR TACHYCARDIA PAROXYSMAL, Parox atrial tachycardia, Paroxysmal supraventricular tachycardia NOS (disorder), paroxysmal supraventricular tachycardia (PSVT), Paroxysmal supraventricular tachycardia (disorder), paroxysmal; tachycardia, supraventricular, tachycardia; paroxysmal, supraventricular, Paroxysmal sup. tachy., Supravent. tach. parox., Tachycardia - parox.sup, Paroxysmal supraventricular tachycardia, Paroxysmal Supraventricular Tachycardia, Tachycardia;supraventr;paroxys
Dutch paroxysmale supraventriculaire tachycardie, paroxysmale tachycardie (supraventriculair), paroxysmaal; tachycardie, supraventriculair, tachycardie; paroxysmaal, supraventriculair
French Tachycardie paroxystique supraventriculaire, Tachycardie paroxystique (supraventriculaire)
German paroxysmale supraventrikulaere Tachykardie, paroxysmale Tachykardie (supraventrikulaer)
Italian Tachicardia parossistica (sopraventricolare), Tachicardia parossistica sopraventricolare
Portuguese Taquicardia supraventricular paroxística
Spanish Taquicardia supraventricular paroxística, Taquicardia paroxística (supraventricular), Supravent. tach. parox., Parox. supravent. tachycardia, Tachycardia - parox.sup, Paroxysmal sup. tachy., taquicardia paroxística supraventricular, SAI (trastorno), taquicardia paroxística supraventricular, SAI, taquicardia supraventricular paroxística (trastorno), taquicardia supraventricular paroxística
Japanese 発作性頻脈(上室性), 発作性上室性頻脈, ホッサセイヒンミャクジョウシツセイ, ホッサセイジョウシツセイヒンミャク
Czech Paroxysmální tachykardie (supraventrikulární), Paroxysmální supraventrikulární tachykardie
Hungarian Paroxysmalis supraventricularis tachycardia, Paroxysmalis tachycardia (supraventricularis)

Ontology: Supraventricular tachycardia (C0039240)

Definition (NCI) A generic expression for any tachycardia that originates in the atria or the atrioventricular node. (NCI)
Definition (NCI) Tachyarrhythmia originating either from the atria or the atrioventricular node.
Definition (NCI) A disorder characterized by a dysrhythmia with a heart rate greater than 100 beats per minute that originates above the ventricles.
Definition (MSH) A generic expression for any tachycardia that originates above the BUNDLE OF HIS.
Concepts Disease or Syndrome (T047)
MSH D013617
ICD10 I47.1
SnomedCT 195104006, 6456007, 155363003, 266305002
English Supraventricular Tachycardias, Tachycardia, Supraventricular, Tachycardias, Supraventricular, SUPRAVENTRICULAR TACHYCARDIA, SVT, TACHYCARDIA SUPRAVENTRICULAR, TACHYCARDIA, SUPRAVENTRICULAR, Tachycardia, supraventricular, Supraventric. tachycardia NOS, Supraventricular tachycardia NOS, SVT - Supraventricular tachy, Supraventricular tachycardia, NOS, supraventricular tachycardia (diagnosis), supraventricular tachycardia, svt, Tachycardia supraventricular, Supraventricular tachycardia NOS (disorder), Tachycardia, Supraventricular [Disease/Finding], tachycardia supraventricular, supraventricular tachycardias, SVT - Supraventricular tachycardia, Supraventricular tachycardia (disorder), supraventricular; tachycardia, tachycardia; supraventricular, Supraventricular tachycardia, Supraventricular Tachycardia
French TACHYCARDIE SUPRAVENTRICULAIRE, TSV, Tachycardie supraventriculaire, Tachycardie supra-ventriculaire
Portuguese TAQUICARDIA SUPRAVENTRICULAR, Taquicardia supraventricular, Taquicardia Supraventricular
Spanish TAQUICARDIA SUPRAVENTRICULAR, TSV, Supraventricular tachycardia, taquicardia supraventricular (trastorno), taquicardia supraventricular, SAI (trastorno), taquicardia supraventricular, SAI, taquicardia supraventricular, Taquicardia supraventricular, Taquicardia Supraventricular
Dutch tachycardie supraventriculair, SVT, supraventriculair; tachycardie, tachycardie; supraventriculair, supraventriculaire tachycardie, Supraventriculaire tachycardie, Tachycardie, supraventriculaire
German SVT, Supraventrikulaere Tachykardie, TACHYKARDIE SUPRAVENTRIKULAER, Tachykardie supraventrikulaer, Supraventrikuläre Tachykardie, Tachykardie, supraventrikuläre
Japanese 上室性頻脈, ジョウシツセイヒンミャク
Swedish Takykardi, supraventrikulär
Finnish Supraventrikulaarinen takykardia
Russian TAKHIKARDIIA SUPRAVENTRIKULIARNAIA, TAKHIKARDIIA NADZHELUDOCHKOVAIA, ТАХИКАРДИЯ НАДЖЕЛУДОЧКОВАЯ, ТАХИКАРДИЯ СУПРАВЕНТРИКУЛЯРНАЯ
Czech SVT, Tachykardie supraventrikulární, Supraventrikulární tachykardie, supraventrikulární tachykardie, tachykardie supraventrikulární
Korean 심실상성 빠른맥
Polish Svt, Tachykardia nadkomorowa, Częstoskurcz nadkomorowy
Hungarian SVT, Tachycardia, supraventricularis, Supraventricularis tachycardia
Italian Tachicardia sopraventricolare