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Source: Sanoski CA, Bauman JL. The Arrhythmias. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7972803. Accessed June 30, 2012.

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  • Paroxysmal supraventricular tachycardia (PSVT) is rapid heart rhythm originating above ventricles that occurs episodically.

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  • May occur in healthy individuals.
  • Premature atrial or ventricular ectopic beats
  • Hyperthyroidism
  • Stimulant use (including caffeine)
  • Previous myocardial infarction, mitral valve prolapse, rheumatic heart disease, pericarditis, pneumonia, chronic lung disease, alcohol intoxication
  • Digoxin toxicity

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  • PSVT arising by reentrant mechanisms includes arrhythmias caused by atrioventricular (AV) nodal reentry, AV reentry incorporating an anomalous AV pathway, sinoatrial (SA) nodal reentry, and intra-atrial reentry.

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  • Prevalence: ~2 cases per 1000 persons in United States.
  • Incidence: 35 cases per 100,000 person-years.

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Signs and Symptoms

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  • Many patients asymptomatic or have only occasional minor palpitations or irregular pulse.
  • Patients may experience:
    • Choking or pressure sensation
    • Dizziness
    • Lightheadedness
    • Shortness of breath
    • Syncope
    • Symptoms of heart failure
    • Anginal chest pain
  • Symptoms may be severe and even life threatening in some patients.
  • Heart rate ranges from 140–240 beats/min and is regular.

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Means of Confirmation and Diagnosis

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  • Electrocardiogram (ECG) shows regular rhythm with rate between 140–240 beats/min.

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Laboratory Tests

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  • May be performed if underlying causes suspected (e.g., hyperthyroidism, digoxin toxicity).

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Differential Diagnosis

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  • Atrial tachycardia, flutter, or fibrillation
  • Atrioventricular nodal reentrant tachycardia (AVNRT)
  • Sinus node dysfunction
  • Ventricular tachycardia or fibrillation

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  • Identify and correct underlying causes.
  • Terminate acute episodes and resolve symptoms.
  • Prevent recurrences.
  • Avoid complications from therapy.

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  • For mild to moderate symptoms, measures that increase vagal tone to AV node (unilateral carotid sinus massage, Valsalva maneuver) used initially.
  • For severe symptoms, synchronized direct current cardioversion (DCC) treatment of choice.

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  • Used for mild to moderate symptoms if nondrug measures fail.
  • Drug selection based on QRS complex (Figure 1).
    • Directly or indirectly increase vagal tone to AV node, with digoxin.
    • Depress conduction through slow, calcium-dependent tissue:
      • Adenosine
      • β-blockers
      • Nondihydropyridine calcium channel blockers
    • Depress conduction through fast, sodium-dependent tissue
      • Quinidine
      • Procainamide
      • Disopyramide
      • Flecainide
  • Adenosine a drug of first choice because its short duration of action will not cause prolonged hemodynamic compromise in patients with wide QRS complexes who actually have ventricular tachycardia rather than PSVT.

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Figure 1.
Graphic Jump Location

Algorithm for treatment of acute (top portion)paroxysmal supraventricular tachycardia and chronic prevention of recurrences (bottom portion). Note: For empiric bridge therapy prior to radiofrequency ablation procedures, calcium channel blockers (or other atrioventricular [AV] nodal blockers) should not be used if patient has AV reentry with accessory pathway. (AAD, antiarrhythmic drugs; AF, atrial fibrillation; AP, accessory pathway; AVN, atrioventricular nodal; AVNRT, atrioventricular nodal reentrant tachycardia; AVRT, atrioventricular reentrant tachycardia; DCC, direct-current cardioversion; ECG, electrocardiographic monitoring; EPS, electrophysiologic studies; PRN, as needed; VT, ventricular tachycardia.) Reprinted with permission from Wells BG, DiPiro JT, Schwinghammer TL, et al. Pharmacotherapy Handbook. 8th ed. ...

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