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 | ====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. | 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 recognised of these is the Valsalva maneuver, which increases intra-thoracic pressure and affects baro-receptors (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 (carotis sinus massage, stimulating carotid baro-receptors) is also effective, but not recommended for those without adequate medical training. | The best recognised of these is the Valsalva maneuver, which increases intra-thoracic pressure and affects baro-receptors (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 (carotis sinus massage, stimulating carotid baro-receptors) is also effective, but not recommended for those without adequate medical training. | ||
==== | ====Acute Pharmacotherapy==== | ||
Another modality involves treatment with medications. Prehospital 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]]. | Another modality involves treatment with medications. Prehospital 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]]. | ||
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[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
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Revision as of 00:31, 12 January 2013
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Supraventricular tachycardia Microchapters |
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Differentiating Among the Different Types of Supraventricular Tachycardia |
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Differentiating Supraventricular Tachycardia from Ventricular Tachycardia |
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Diagnosis |
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Treatment |
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2015 ACC/AHA Guideline Recommendations |
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Case Studies |
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Supraventricular tachycardia medical therapy On the Web |
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American Roentgen Ray Society Images of Supraventricular tachycardia medical therapy |
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Directions to Hospitals Treating Supraventricular tachycardia |
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Risk calculators and risk factors for Supraventricular tachycardia medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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 manoevres. These manoevres 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:
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 recognised of these is the Valsalva maneuver, which increases intra-thoracic pressure and affects baro-receptors (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 (carotis sinus massage, stimulating carotid baro-receptors) is also effective, but not recommended for those without adequate medical training.
Acute Pharmacotherapy
Another modality involves treatment with medications. Prehospital 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.