Supraventricular Tachycardia Management in the Adult

Aka: Supraventricular Tachycardia Management in the Adult

1. See Also
   1. Unstable Tachycardia
   2. Narrow Complex Tachycardia
   3. Wide Complex Tachycardia
   4. Cardiopulmonary Resuscitation
   5. Supraventricular Tachycardia Management in the Child
2. Step 1: Is patient unstable
   1. Criteria
      1. Altered mental status
      2. Chest Pain persistent
      3. Hypotension
   2. Management
      1. Stable
         1. Go to Step 2
      2. Unstable:
         1. Go to Unstable Tachycardia for Synchronized Cardioversion
3. Step 2: Regular or Irregular Narrow Complex Tachycardia
   1. Regular Narrow Complex Tachycardia
      1. Vagal maneuvers
      2. Adenosine 6 mg IV (may repeat at 12 mg IV)
      3. Go to Step 3 below
   2. Irregular Narrow Complex Tachycardia
      1. Causes
         1. Atrial Fibrillation (most likely)
         2. Atrial Flutter
         3. Multifocal Atrial Tachycardia
      2. Management
         1. Consider consultation with cardiology
         2. Rate control
            1. Diltiazem 15-30 mg IV
            2. Lopressor 5 mg IV (avoid in acute CHF or COPD exacerbation)
4. Step 3: Regular Narrow Complex Tachycardia
   1. Rhythm converts with basic measures in step 2 (vagal maneuvers and Adenosine)
      1. Suggests Reentry Supraventricular Tachycardia
      2. Recurrence management
         1. Adenosine or
         2. AV nodal blocking agent (e.g, Diltiazem, Beta Blocker)
   2. Rhythm does not convert
      1. Causes
         1. Atrial Flutter
         2. Ectopic Atrial Tachycardia
         3. Junctional Tachycardia
      2. Management
         1. Consider consultation with cardiology
         2. Treat underlying cause
            1. See Reversible Causes of Cardiopulmonary Arrest (5H5T)
         3. Rate control
            1. Diltiazem 15-30 mg IV
            2. Lopressor 5 mg IV (avoid in acute CHF or COPD exacerbation)
5. Management: Long-term management
   1. Medication control
   2. Radiofrequency ablation
      1. Accessory Pathway (e.g. WPW)
      2. Atrioventricular nodal reentrant Tachycardia
      3. Atrial Tachycardia
6. References
   1. (2000) Circulation, 102(Suppl I):86-9
   2. http://www.circulationaha.org