Supraventricular Tachydysrhythmias in the Emergency Department -

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Publication Date: August 2020 (Volume 22, Number 8)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 8/01/2023.

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Peer Reviewers

Abstract

Diagnosing and treating supraventricular tachycardias is routine in emergency medicine, and new strategies can improve efficiency and outcomes. This review provides an overview of supraventricular tachycardias, their pathophysiology, differential diagnosis, and electrocardiographic features. Clinical evidence guiding contemporary practice is determined largely by multiple observational studies, with few randomized controlled trials. Current prehospital and emergency department management strategies beyond the use of adenosine and calcium channel blockers are addressed. Diagnostic and therapeutic recommendations are provided, based on the best available evidence.

Excerpt From This Issue

A 31-year-old woman presents to the ED with palpitations. The ECG shows a regular, narrow complex tachycardia with a rate of 170 beats/min. She has a history of AV nodal re-entry tachycardia. Her vital signs are reassuring, with a blood pressure of 127/81 mm Hg. Adenosine has successfully converted her dysrhythmia in the past, but she asks whether there is an alternative treatment, because she hates the way it makes her feel. You are considering this patient’s request when another patient’s ECG is handed to you.