Supraventricular tachycardia medical therapy: Difference between revisions

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AV nodal blocking can be achieved in at least three different ways:
AV nodal blocking can be achieved in at least three different ways:
====Physical Maneuvers====
A number of physical maneuvers cause increased AV nodal block, principally through activation of the parasympathetic nervous system, conducted to the heart by the [[vagus nerve]]. These manipulations are therefore collectively referred to as vagal maneuver. 
The best recognized of these is the Valsalva maneuver, which increases intra-thoracic pressure and affects baroreceptors (pressure sensors) within the arch of the [[aorta]]. This can be achieved by asking the patient to hold their breath and bear down as if straining to pass a bowel motion, or less embarrassingly, by getting them to hold their nose and blow out against it. Plunging the face into, or just drinking a glass of ice cold water is also often effective. Firmly pressing the bulb at the top of one of the carotid arteries in the neck ([[carotid sinus]] massage, stimulating carotid [[baroreceptors]]) is also effective, but not recommended for those without adequate medical training.


====Acute Pharmacotherapy====
====Acute Pharmacotherapy====

Latest revision as of 10:14, 10 June 2017

Supraventricular tachycardia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Among the Different Types of Supraventricular Tachycardia

Differentiating Supraventricular Tachycardia from Ventricular Tachycardia

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

Chest X Ray

Echocardiography

Cardiac Catheterization

Other Diagnostic Studies

Treatment

Medical Therapy

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2015 ACC/AHA Guideline Recommendations

Acute Treatment of SVT of Unknown Mechanism
Ongoing Management of SVT of Unknown Mechanism
Ongoing Management of IST
Acute Treatment of Suspected Focal Atrial Tachycardia
Acute Treatment of Multifocal Atria Tachycardia
Ongoing Management of Multifocal Atrial Tachycardia
Acute Treatment of AVNRT
Ongoing Management of AVNRT
Acute Treatment of Orthodromic AVRT
Ongoing Management of Orthodromic AVRT
Asymptomatic Patients With Pre-Excitation
Management of Symptomatic Patients With Manifest Accessory Pathways
Acute Treatment of Atrial Flutter
Ongoing Management of Atrial Flutter
Acute Treatment of Junctional Tachycardia
Ongoing Management of Junctional Tachycardia
Acute Treatment of SVT in ACHD Patients
Ongoing Management of SVT in ACHD Patients
Acute Treatment of SVT in Pregnant Patients
Acute Treatment and Ongoing Management of SVT in Older Population

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Medical Therapy

Acute Treatment

In general, SVT is not life threatening, but episodes should be treated or prevented. While some treatment modalities can be applied to all SVTs with impunity, there are specific therapies available to cure some of the different sub-types. Cure requires intimate knowledge of how and where the arrhythmia is initiated and propagated.

The SVTs can be separated into two groups, based on whether they involve the AV node for impulse maintenance or not. Those that involve the AV node can be terminated by slowing conduction through the AV node. Those that do not involve the AV node will not usually be stopped by AV nodal blocking maneuvers. These maneuvers are still useful however, as transient AV block will often unmask the underlying rhythm abnormality.

AV nodal blocking can be achieved in at least three different ways:

Acute Pharmacotherapy

Another modality involves treatment with medications. Pre-hospital care providers and hospital clinicians might administer adenosine, an ultra short acting AV nodal blocking agent. If this works, followup therapy with diltiazem, verapamil or metoprolol may be indicated. SVT that does NOT involve the AV node may respond to other anti-arrhythmic drugs such as sotalol or amiodarone.

In pregnancy, metoprolol is the treatment of choice as recommended by the American Heart Association.

References


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