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Supraventricular tachycardia

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Slide 1 :

Supraventricular tachycardia ??????????? ?????

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Supraventricular tachycardia (SVT) Physiologic tachycardia Sinus tachycardia Atrial tachyarrhythmias Inappropriate sinus tachycardia Sinus nodal reentrant tachycardia Ectopic atrial tachycardia Multifocal atrial tachycardia Atrial flutter Atrial fibrillation

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Supraventricular tachycardia (SVT) Atrioventricular tachyarrhythmias Atrioventricular nodal reentrant tachycardia Atrioventricular reentrant tachycardia Junctional Ectopic tachycardia Nonparoxysmal junctional tachycardia

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Supraventricular tachycardia (SVT) Distinction of physiologic and pathologic: Vital sign History P.E. ECG

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Supraventricular tachycardia (SVT) Physiologic tachycardia: Sepsis Dehydration Hemorrhagic shock

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Supraventricular tachycardia (SVT) Clinical presentation: No symptoms Palpitation Dizziness Chest pain syncope

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Supraventricular tachycardia (SVT) Incidence and prevalence Firstly recognized since 1909 Prevalence: 2.25/1000 persons Incidence: 35/ 100000 person-years 89000 new cases /year >1 million persons with SVT in USA The most common arrhythmia of childhood

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Supraventricular tachycardia (SVT) Clinical presentation: Palpitation(96%) dizziness(75%) SOB(47%) fatigue(23%) chest pain(35%)

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Supraventricular tachycardia (SVT) Diaphoresis(17%) Nausea(13%) Syncope / life-threatening arrhythmias(20%) Neck pounding-------AVNRT

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Supraventricular tachycardia (SVT) Onset and duration: Circadian rhythms Physical stress Mental stress Pregnancy Drugs----digitalis, albuterol, sympathomimetics

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Supraventricular tachycardia (SVT) Classification: The tissue involved The mechanism generating the tachyarrhythmias over intracardiac monitoring

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Supraventricular tachycardia (SVT) Sinus tachycardia: Response to stressors Not arrhythmia Physiologic Pharmacologic Patho-physiologic

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Supraventricular tachycardia (SVT) Gradual onset Gradual acceleration Gradual deceleration HB: 100-180 bpm Formula: 220-patient’s age

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Supraventricular tachycardia (SVT) Inappropriate sinus tachycardia (IST): Tachycardia without stressor May be an arrhythmia Young women Diagnosis of exclusion DDx: pheochromocytoma hyperthyroidism

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Supraventricular tachycardia (SVT) Mechanism: 1.Ectopic atrial focus located closely to the sinoatrial node 2.Hypersensitivity to catecholamines Minimal exertion -----increased HB ECG: 1.Same as sinus tachycardia 2. P wave -----slightly variable

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Supraventricular tachycardia (SVT) Sinus nodal reentrant tachycardia (SNRT) Reentry circuit in sinoatrial node ECG in common as sinus tachycardia P wave ----nearly identical to sinus P in sinus tachycardia Abrupt onset and termination HB------100-150 bpm

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Supraventricular tachycardia (SVT) Multifocal atrial tachycardia ECG:?3 P morphologies HB---100-200 bpm Irregular tachycardia P.E.: ‘a’ wave in jugular venous pulsations Mechanism: enhanced automaticity/ triggered activity

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Supraventricular tachycardia (SVT) Ill and Elderly COPD Sepsis Acidosis Hypoxia Drugs-----theophylline, beta-agonists Electrolyte inbalance

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Supraventricular tachycardia (SVT) Ectopic atrial tachycardia Rare arrhythmia Reentry or abnormal automaticity over atrial tissue Cause tachycardia-induced cardiomyopathy Cardiac or pulmonary disease Different P wave morphology HB---120-250 bpm

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May be an arrhythmia. Young women. Diagnosis of exclusion. DDx: pheochromocytomaRare arrhythmia. Re more May be an arrhythmia. Young women. Diagnosis of exclusion. DDx: pheochromocytomaRare arrhythmia. Reentry or abnormal automaticity over atrial tissue ... less