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Supraventricular Tachycardia Management in the Adult

Aka: Supraventricular Tachycardia Management in the Adult, Narrow Complex Tachycardia in the Adult, Supraventricular Tachycardia in the Adult, Paroxysmal Supraventricular Tachycardia in the Adult, PSVT in the Adult
  1. See Also
    1. Supraventricular Tachycardia
    2. Atrioventricular Nodal Reentry (AVNRT)
    3. Atrioventricular Reciprocating Tachycardia (AVRT)
    4. Atrial Tachycardia
    5. Unstable Tachycardia
    6. Sinus Tachycardia
    7. Atrial Fibrillation
    8. Unstable Tachycardia
    9. Narrow Complex Tachycardia
    10. Wide Complex Tachycardia
    11. Cardiopulmonary Resuscitation
    12. Supraventricular Tachycardia Management in the Child
  2. Approach: 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. Approach: Step 2 - Regular or Irregular Narrow Complex Tachycardia
    1. Regular Narrow Complex Tachycardia
      1. Vagal Maneuvers
      2. Valsalva Maneuver
        1. See Valsalva for positional modifications (increased efficacy)
      3. Adenosine 6 mg IV (may repeat at 12 mg IV)
      4. 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. Avoid Adenosine in irregular Narrow Complex Tachycardia (due to risk of Ventricular Fibrillation)
        3. Rate control
          1. Diltiazem
            1. Bolus 1: 20 mg (0.25 mg/kg) IV bolus over 2 min
            2. Bolus 2: 25 mg (0.35 mg/kg) IV bolus over 2 min (if indicated, and at least 15 min after first)
            3. Drip: 10 mg/hour (typical range: 5-15 mg/hour)
          2. Metoprolol (Lopressor)
            1. Avoid in acute CHF or COPD exacerbation
            2. Bolus: 2.5 to 5 mg IV every 2-5 min (maximum 15 mg in 15 min)
  4. Approach: 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)
          1. See Diltiazem and Metoprolol dosing under rate control above
    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. See Diltiazem and Metoprolol dosing under rate control as above
  5. Management: Long-term management
    1. Infrequent episodes ("pill in the pocket" prn strategy)
      1. Diltiazem 120 mg orally AND Propranolol 80 mg orally once prn
      2. Flecainide 3 mg/kg orally once prn
      3. Alboni (2001) J Am Coll Cardiol 37(2): 548-53 [PubMed]
    2. Frequent episodes
      1. Medication options
        1. Diltiazem 240 to 360 mg orally daily
        2. Metoprolol 25 to 100 mg orally twice daily
        3. Flecainide 50-100 mg orally daily divided every 8-12 hours
          1. Typically not prescribed by primary care (limited to cardiology in most cases)
      2. Do not use long-term prophylaxis in Wolff-Parkinson-White Syndrome (WPW)
        1. Risk of Ventricular Fibrillation
        2. Consult for catheter ablation in symptomatic patients
    3. 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
      1. http://www.circulationaha.org
    2. Helton (2015) Am Fam Physician 92(9): 793-800 [PubMed]

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 electrocardiographic finding of episodic supraventricular tachycardia with abrupt onset and termination.
Concepts Disease or Syndrome (T047)
ICD9 427.0
SnomedCT 195074009, 266305002, 155363003, 67198005
English Paroxysm.supravent.tachyc. NOS, Paroxysmal supravent.tachycard, Paroxysmal supraventricular tachycardia NOS, PSVT, paroxysmal supraventricular tachycardia (diagnosis), paroxysmal supraventricular tachycardia, Paroxysmal tachycardia (supraventricular), Parox atrial tachycardia, paroxysmal supraventricular tachycardia (PSVT), psvt, Paroxysmal supraventricular tachycardia NOS (disorder), Paroxysmal sup. tachy., Tachycardia - parox.sup, Supravent. tach. parox., Paroxysmal Supraventricular Tachycardia by ECG Finding, Paroxysmal Supraventricular Tachycardia by EKG Finding, Paroxysmal Supraventricular Tachycardia, Paroxysmal supraventricular tachycardia (disorder), paroxysmal; tachycardia, supraventricular, tachycardia; paroxysmal, supraventricular, 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), 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)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Supraventricular tachycardia (C0039240)

Definition (NCI) A disorder characterized by an electrocardiographic finding of a tachycardia which does not originate in the ventricles or His Purkinje system. There is an abnormally high heart rate and QRS complexes are typically narrow, but aberration or preexcitation may be present. (CDISC)
Definition (NCI_CTCAE) 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, 266305002, 155363003, 6456007
LNC LA17100-1
English Supraventricular Tachycardias, Tachycardia, Supraventricular, Tachycardias, Supraventricular, SVT, TACHYCARDIA SUPRAVENTRICULAR, Supraventric. tachycardia NOS, Supraventricular tachycardia NOS, SVT - Supraventricular tachy, supraventricular tachycardia (diagnosis), supraventricular tachycardia, Tachycardia supraventricular, Tachycardia, Supraventricular [Disease/Finding], tachycardia supraventricular, supraventricular tachycardias, Supraventricular tachycardia (SVtach), Supraventricular tachycardia NOS (disorder), SVT - Supraventricular tachycardia, Supraventricular tachycardia (disorder), supraventricular; tachycardia, tachycardia; supraventricular, Supraventricular tachycardia, NOS, Supraventricular tachycardia, Supraventricular Tachycardia
French TACHYCARDIE SUPRAVENTRICULAIRE, TSV, Tachycardie supraventriculaire, Tachycardie supra-ventriculaire
Portuguese TAQUICARDIA SUPRAVENTRICULAR, Taquicardia supraventricular, Taquicardia Supraventricular
Spanish TAQUICARDIA SUPRAVENTRICULAR, TSV, taquicardia supraventricular, SAI (trastorno), taquicardia supraventricular, SAI, taquicardia supraventricular (trastorno), 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, supraventrikulární tachyarytmie
Korean 심실상성 빠른맥
Polish Svt, Tachykardia nadkomorowa, Częstoskurcz nadkomorowy
Hungarian SVT, Tachycardia, supraventricularis, Supraventricularis tachycardia
Norwegian Supraventrikulær takykardi
Italian Tachicardia sopraventricolare
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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