Supraventricular tachycardia
Questionnaire/history:
Palpitations?
Sudden onset?
Sudden offset?
Chest pain?
Shortness of breathing?
Light-headedness?
Anxiety?
Past medical history?
Current medication?
Known drug allergies?
Examination:
Airway?
Breathing?
Circulation?
- Heart rate?
- Blood pressure?
Investigation:
ECG?
- Regular narrow complex tachycardia?
--- AV nodal re-entry tachycardia (AVNRT)?
--- Atrioventricular re-entry tachycardia (AVRT))?
------ Wolff-Parkinson White syndrome?
- Broad complex tachycardia (ventricular tachycardia until proven otherwise – admit urgently)?
Management:
Unstable?
If yes, admit urgently, BLS/ALS if needed
Stable?
If yes:
Adults:
Valsalva manoeuvre (without side effects/risks):
15 seconds strain at 40mmg/Hg (if difficult to determine pressure, ask to blow into a 10ml syringe enough to move a plunger that has already been moved by hand (not fresh from packet)?
Trendelenburg position (head down) Valsalva (increased conversion to 31%)?
Modified Valsalva (now the first line)?
(Note: REVERT trial showed increased conversion to sinus rhythm from 17% in the standard Valsalva group to 43% in the modified Valsalva group)
Valsalva in upright position followed by supine position with legs elevated to increase venous return to the heart (could be done with 10ml syringe)
Carotid sinus massage (no longer recommended, as inferior efficacy with a 10% conversion rate and possible side effects/risks including stroke)?
Valsalva manoeuvre
Diving reflex (fill a washing-up bowl full of cold water, and add some ice if you have some. Ask the child to hold their breath and put their whole face under the cold water for a few seconds)?
Vomit reflex (ask the child to put their finger down their throat as if they were trying to make themselves sick)?
If fails to respond to the modified Valsalva response, refer to A & E for consideration of intravenous adenosine (or verapamil) where full monitoring and resuscitation facilities are available
Resource(s):
NICE CKS