Supraventricular tachycardia (SVT) | ACLS-Algorithms.com

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  1. Regan says

    I’m just learning. I work in a cardiologist office and we have a patient that had been to the emergency room with a heart rate in the 170’s Her ekg showed atrial flutter.
    She was unconscious and the doctor I work for says whether atrial flutter/ svt it would not make a patient unconscious. I have to admit this is the first I’ve actually heard a patient being unconscious but is it really possible? There were no drugs in her system as all were negative.

    • Jeff with admin. says

      There are instances where atrial flutter or SVT could make a patient become unconscious. That is possible. If a patient has new onset atrial flutter or SVT and they become unconscious and you cannot determine any other cause for the unconsciousness, it would be logical and acceptable to associate the cause of the unconsciousness with the atrial flutter or SVT until proven otherwise.

      Kind regards,
      Jeff

    • Jeff with admin. says

      PAT is a form of SVT which originates within the atria but outside of the sinus node. Atrial flutter and multifocal atrial tachycardia are specific types of atrial tachycardia.

      If a patient is symptomatic and UNSTABLE then the treatment would be cardioversion.

      If a patient is symptomatic and STABLE then the treatment would vary depending of the cause of the PAT. In many cases, PAT will be asymptomatic and needs not treatment. However, in other cases such as toxicity, caffeine, or scarring on the heart. There are different treatments for each.

      Kind regards,
      Jeff

  2. okto says

    i’ve read some literature, the atrial tachycardia were classified as psvt and svt, how to differenciate them? or is it just the same?

    • Jeff with admin. says

      Technically atrial tachycardia is different from SVT when it comes to SVT as presented within ACLS. When you think of arrhythmias, think of them in the two categories.
      1. Arrhythmias above the ventricles (supraventricular)
      2. Arrhythmias in the ventricles

      SVT is a very generic term and within the framework of ACLS (I wish AHA would be more specific), SVT for ACLS purposes is typically referring to AVNRT and AVRT.

      Atrial tachycardia is a type of SVT because it is supraventricular in nature, but because of the general nature of the word SVT and how the AHA ACLS provider manual uses the word, it can be confusing.

      This can get a bit technical and so I have provided a link to a great article about SVT that may hopefully help clarify things for you.
      Supraventricular Tachycardia Explained

      I hope this helps.

      Kind regards,
      Jeff

  3. David says

    Is there a way to distinguish between atrial tachycardia and SVT? I know AT is a form of SVT, however, i was taking a practice test for my NREMTP and was given a rhythm strip for interpretation… HR 170 regular narrow QRS, p waves buried in the T wave… I chose SVT, but the answer said AT.

    • Jeff with admin. says

      It can be difficult to distinguish between AT and SVT. Here are two things that may help.

      1. Typically, the rate for SVT is going to be extreemly high. Greater than 200. Not always but typically. If it is below 200 question whether it is really SVT.
      2. With AT you can often times make out inverted P-waves (Lead II) that are buried in the T-wave. Retrograde p-waves are typical because the electrical impulse is being generated within the atrial from a different than normal position (Ectopic).

      I hope this helps.

      Kind regards,
      Jeff

  4. madambac12 says

    I’m still having difficulty differentiating between stable and unstable patients. In the intro, you state
    “An unstable tachycardia exists when cardiac output is reduced to the point of causing serious signs and symptoms.
    Serious signs and symptoms commonly seen with unstable tachycardia are: chest pain, signs of shock, SOA (short of air), altered mental status, weakness, fatigue, and syncope”

    Yet in the svt section, you differentiate between stable and unstable.
    Shortness of air (S)
    Palpitation feeling in chest (S)
    Ongoing chest pain (U)
    Dizziness (S)
    Rapid breathing (S)
    Loss of consciousness (U)
    Numbness of body parts (S)

    So a person who is short of air, palpitation feeling in chest, rapid breathing, dizziness, and numbness of body parts is considered stable?

    Can you please clarify. thanks!!

    • Jeff with admin. says

      Yes, a person who is short of air, palpations, rapid breathing, dizziness, and numbness and could be considered stable with SVT. The reason is that this type of SVT.
      Typically unstable SVT and in fact any type of unstable tachycardia will involve chest pain, hypotension and changes in LOC.

      Kind regards,
      Jeff

  5. Jeckson Mureri says

    You have explained SVT, thanx J,
    can you also help me in identifying & distinguishing polymorphic and monophonic tachycardia they confuse me a lot

    • Jeff with admin. says

      Persistent SVT will probably require an electrophysiology study to determine the mechanism of the disorder. This will allow for proper treatment of the arrhythmia.

      Kind regards,
      Jeff

    • Jeff with admin. says

      A vagal maneuver is a technique by which you attempt to increase intrathroacic pressure which will stimulate the vagus nerve. This can result in slowed conduction of electrical impulses through the AV node of the heart. There are a number of ways to do it here are a couple:

      1. Cough Method: Have the patient cough forcefully. This is a simple form of vagal maneuver. The idea is to increase intrathroacic pressure which will stimulate the vagus nerve. This can result in slowed conduction of electrical impulses through the AV node of the heart.
      2. Straw Method: Have the patient blow forcefully through a straw for 3-5 seconds.
      3. Bear down Method: Have the patient bear down and strain. Kind of like how a person might strain when having a bowel movement.
      4. Syringe Plunger Method: First, show the patient how easy it is to move the plunger by pulling it back and forth in within the syringe and then have the patient. Have the patient place their mouth over the exit end of the syringe and attempt to blow the plunger out of the syringe. Have them blow for 3-5 seconds.
      5. Abdominal Pressure Method: Press into the pts abd while they contract and resist pressing into their abd.
      6. Ice Method: Quote from a healthcare provider: “We had a kid (approximately 12 yrs old) present to our ER in SVT, instead of using drugs and vagal maneuvers we dunked his face in a bucket of ice twice and it immediately & effectively brought the heart rate down. We observed him for a period of time and the kid was fine. Worked wonders! Young army doctor’s idea!”

      Hope this helps. Kind regards, Jeff

      • Les says

        I have used this method myself at home numerous times to slow a tachy heart rate. Cold tap water with no ice in the bathroom sink worked well, due to the body’s natural reaction to protect itself from drowning (all body systems slow down when the body or even face is submerged in water).

  6. ChrisL says

    If pt has not converted after vagaries man. and has had a total of 18mg of Adenosine admin per our protocol, should we consider cardioverting? Or monitor pt en route and call MD at receiving facility for consultation?

    • Jeff with admin. says

      At this stage, a cardiologist should be involved in the next treatment options. As long as the patient is stable, this would be the case. At any point if the patient becomes unstable you would perform cardioversion.

      Kind regards,
      Jeff

    • Jeff with admin. says

      Yes, premature atrial tachycardia (PAT) would be considered a of supraventricular tachycardia. Not sure what you mean by PAF, but if you mean atrial fibrillation with a rapid ventricular rate then yes, this would also fit the criteria for SVT.

      Kind regards,
      Jeff

      • Michaela says

        We usually refer : PAT and PAF as paroxysmal atrial tach and paroxysmal atrial fibrillation when the event starts suddenly, and many SVT events do start suddenly

    • Jeff with admin. says

      The 4 most common types of SVT are A-V Nodal Reentry Tachycardia, A-V
      Reentry Tachycardia, atrial tachycardia and atrial flutter. These rhythms are regular in nature and have a rate > 150. To distinguish the difference between the re-entry tachycardias and the other types really requires a 12 lead ECG. The diagnostic criteria to determine that it is a reentrant tachycardia is actually quite complex. I attached a pic from my 12 lead ecg pocket reference that will help. Reentry tachycardias are very easy to convert and often vagal maneuvers will suffice to terminate the tachycardia.

      Kind regards,
      Jeff

  7. Linsey says

    Lets say I have a pt hooked up to a basic tele monitor and she goes into SVT. Vagal maneuvers are attempted and doctor orders Adenosine. Would you then hook her up to the code cart prior to giving the Adenosine.?

    • Linsey says

      Oh and the patient is in stable condition.
      And would your answer be different if the patient had multiple reentrys into SVT and successful Adenosine administrations? Or maybe just having the code cart at bedside? Can Adenosine cause lethal arrhythmias?

      • Jeff with admin. says

        The crash cart would not be necessary, but it could be close at hand in the case that the patient becomes unstable. Adenosine does not normally precipitate lethal arrhythmias.

        Kind regards,
        Jeff

    • Jeff with admin. says

      Having the code cart prior to giving adenosine would not be necessary. It would not hurt, but it would not be necessary. Adenosine rapid IV push will not usually precipitate pulseless VT or VF.

      Kind regards,
      Jeff

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