Page 28 - Delaware Medical Journal - July/August 2019
P. 28
Abstract
INTRODUCTION
Supraventricular tachycardia is an umbrella term that describes any tachycardia (i.e., atrial and/or ventricular rates greater than 100 beats per minute
at rest) originating from the bundle of His or above. This includes inappropriate
focal and multifocal atrial tachycardia, macroreentrant atrial tachycardia (e.g., atrioventricular nodal reentry tachycardia (AVNRT), and various forms of accessory pathway-mediated reentrant tachycardias (e.g., orthodromic and antidromic atrioventricular reentry tachycardia).1 AVNRT is the most common SVT
and is usually seen in young adults with no structural or ischemic heart disease presenting with acute onset of palpitations. It is caused by a reentrant
circuit within or around the AV node, and ventricular rates are typically between 140-280 bpm. AVNRT is rarely life- morbidity if left untreated. In practice, SVT is commonly used to describe AVNRT, so we will use the terms interchangeably for this discussion.
CASE REPORT
A 20-year-old female with a past
hyperactivity disorder on amphetamine- dextroamphetamine presented to the emergency department (ED) with complaint of intermittent palpitations for the past seven days. Over that time, the palpitations increased in frequency and duration. On the day of presentation, she was seen at her college student health
tachycardic and sent her to the ED. She had no other complaints aside from the palpitations. She had no prior cardiac history nor family history of cardiac disease or early cardiac death. She denied any recent travel, smoking, alcohol use, or recreational drug use. There had been no changes in the dose or formulation
of her prescribed amphetamine- dextroamphetamine, which she had been taking for many years.
Her initial electrocardiogram (EKG) in the ED showed a regular narrow complex tachycardia at a rate of 180-190 bpm
with no P-waves preceding the QRS complexes (EKG 1). The presence of retrograde P-waves following the QRS complexes suggested the diagnosis of atrioventricular nodal reentry tachycardia (AVNRT) or orthodromic atrioventricular reentry tachycardia (AVRT). The lack of AV dissociation made narrow complex
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Del Med J | July/August 2019 | Vol. 91 | No. 4
When All Else
Fails: Treatment
of Recurrent and
Refractory SVT
Vitaliy Belyshev, MD; Jeremy Berberian, MD; Jonathan McGhee, DO
Supraventricular tachycardia (SVT) is a common diagnosis seen and treated in the emergency department (ED). We present a case of a 20-year- old female with SVT refractory to traditional treatments. This case illustrates the challenges
in managing a patient who has a successful
but non-sustained response to treatment, a dilemma that is not well studied. We review several different methods in the approach to SVT treatment, including pharmacological and non- pharmacological therapies.
