II. Definition
- Rapid heart rhythms originating in the atrium or atrioventricular node
- Transmit via the bundle of His and result in rapid ventricular response
III. Epidemiology
- Prevalence: 2-3 per 1000 persons (U.S.)
- Age (mean): 45 years old
- Gender: Women represent 62% of cases
IV. Causes: Narrow Complex Tachycardia (Mnemonic: 5H 5T PS)
- Similar list to Reversible Causes of Cardiopulmonary Arrest (5H5T)
- Hypoxemia
- Hypovolemia
- Hyperthermia
- Hyperkalemia
- Hypokalemia
- Tamponade (Cardiac Tamponade)
- Tension Pneumothorax
- Toxins, medications and drugs
- Caffeine
- Tobacco
- Alcohol
- Pseudophedrine (or other Sympathomimetics)
- Thrombus
- Pain or Stress
- Structural abnormalities (especially in children)
V. Types: Narrow Complex Tachycardia
- Sinus Tachycardia
- Supraventricular Tachycardia
- Atrioventricular Nodal Reentry (AVNRT)
- Signal down the slow AV nodal pathway and retrograde up the fast AV nodal pathway
- In 10% of cases, the signal reentry route is reversed
- Atrioventricular Reciprocating Tachycardia (AVRT)
- Includes Wolff-Parkinson-White Syndrome (characterized by delta wave)
- Accessory pathway outside the AV node
- Orthodromic (narrow complex): Signal down the AV node and up the accessory path
- Antidromic (wide complex): Signal down the accessory path and up the AV node
- Atrial Tachycardia (AT)
- Atrioventricular Nodal Reentry (AVNRT)
- Other Atrial Tachycardias with rapid ventricular response
VI. Differential Diagnosis: Adults - Narrow Complex Tachycardia (key question is 'regular or irregular')
- Sinus Tachycardia (regular)
- Irregular Supraventricular Tachycardia (may also present as wide complex if aberrancy)
- Regular Supraventricular Tachycardia
- Atrial Flutter
- Atrioventricular Nodal Reentry (AVNRT): 60% of SVT cases (esp. women)
- Atrioventricular Reciprocating Tachycardia (AVRT): 30% of SVT cases
- Atrial Tachycardia (AT): 10% of SVT cases
VII. Differential Diagnosis: Children - Narrow Complex Tachycardia
- Common
- Orthodromic Atrioventricular Reciprocating Tachycardia (Orthodromic AVRT, or ORT)
- Most common in children (typical, narrow complex SVT)
- Atrioventricular Nodal Reentry (AVNRT)
- Second most common SVT in children (but rare in young children)
- Orthodromic Atrioventricular Reciprocating Tachycardia (Orthodromic AVRT, or ORT)
- Uncommon
- Ectopic Atrial Tachycardia
- Similar to sinus rhythm except for altered P Wave appearance and more rapid rate
- Atrial Flutter (uncommon in children outside the newborn period)
- Atrial Fibrillation (very rare in children)
- Ectopic Atrial Tachycardia
-
Congenital Heart Disease history
- CHD predisposes patients to scarring with risk of reentrant pathways
- Intra-atrial reentrant Tachycardia (IART)
- Appears similar to Atrial Flutter
- Typically treated with rate control on Diltiazem (if over age 2-5 years), followed by cardioversion
VIII. History
- Timing
- Rapid onset and resolution
- Supraventricular Tachycardia
- Slow onset and resolution
- Rapid onset and resolution
- Precipitating factors
- Caffeine or stimulants, stress
- Supraventricular Tachycardia or Sinus Tachycardia
- Cardiovascular disease or onset with activity
- Caffeine or stimulants, stress
IX. Symptoms: Episodic
- Anxiety
- Chest pressure
- Dyspnea
- Fatigue
- Light headed
- Palpitations
X. Signs: Electrocardiogram
-
Sinus Tachycardia
- P Waves present and normal
- Variable R-R with constant PR interval
- Heart Rate varies with activity
- Rate lower than PSVT
- Infants < 220 (may approach this with fever)
- Children < 180
- Adults < 160
- Supraventricular Tachycardia
- P Waves absent or abnormal
- Fixed Heart Rate (constant R-R)
- Abrupt rate change
- Rate higher than Sinus Tachycardia (especially if Heart Rate twice normal for age or higher)
- Infants > 220
- Children > 180
- Adults > 160
XI. Labs
- Thyroid Stimulating Hormone (TSH)
- Basic metabolic panel
- Complete Blood Count
- Chest XRay
- Additional tests to consider (in adults)
XII. Management: Stable Patients
- New emphasis on use of one Antiarrhythmic
- Contrast to prior Antiarrhythmic soups
- Pro-arrhythmic effects increase with poly-drugs
- Supraventricular Tachycardia Management in the Adult
- Supraventricular Tachycardia Management in the Child
XIII. Management: Unstable Patients
XIV. Management: Cardiology Consultation Indications
- Uncertain diagnosis or management
- Recurrent Supraventricular Tachycardia refractory to medications
- High risk profession or activity (e.g. truck driver, airline pilot, rock climbing, Scuba Diving)
- Ablation considered over medication (patient preference)
- Wolff-Parkinson-White Syndrome (characterized by delta wave)
- Structural heart disease (e.g. Hypertrophic Cardiomyopathy)
- Syncope associated with Supraventricular Tachycardia
- Wide complex on EKG
XV. References
- Claudius, Behar and Bar Cohen in Herbert (2014) EM:Rap 14(5):1-2
- Hebbar (2002) Am Fam Physician 65(12):2479-86 [PubMed]
- Helton (2015) Am Fam Physician 92(9): 793-800 [PubMed]
- Cardiopulmonary Resuscitation Guidelines
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Related Studies
Definition (CHV) | periods of very rapid heart beats that begin and end abruptly |
Definition (CHV) | periods of very rapid heart beats that begin and end abruptly |
Definition (NCI) | An electrocardiographic finding of episodic supraventricular tachycardia with abrupt onset and termination. |
Concepts | Disease or Syndrome (T047) |
ICD9 | 427.0 |
SnomedCT | 195074009, 266305002, 155363003, 67198005 |
English | Paroxysm.supravent.tachyc. NOS, Paroxysmal supravent.tachycard, Paroxysmal supraventricular tachycardia NOS, PSVT, paroxysmal supraventricular tachycardia (diagnosis), paroxysmal supraventricular tachycardia, Paroxysmal tachycardia (supraventricular), Parox atrial tachycardia, paroxysmal supraventricular tachycardia (PSVT), psvt, Paroxysmal supraventricular tachycardia NOS (disorder), Paroxysmal sup. tachy., Tachycardia - parox.sup, Supravent. tach. parox., Paroxysmal Supraventricular Tachycardia by ECG Finding, Paroxysmal Supraventricular Tachycardia by EKG Finding, Paroxysmal Supraventricular Tachycardia, Paroxysmal supraventricular tachycardia (disorder), paroxysmal; tachycardia, supraventricular, tachycardia; paroxysmal, supraventricular, Paroxysmal supraventricular tachycardia, Tachycardia;supraventr;paroxys |
Dutch | paroxysmale supraventriculaire tachycardie, paroxysmale tachycardie (supraventriculair), paroxysmaal; tachycardie, supraventriculair, tachycardie; paroxysmaal, supraventriculair |
French | Tachycardie paroxystique supraventriculaire, Tachycardie paroxystique (supraventriculaire) |
German | paroxysmale supraventrikulaere Tachykardie, paroxysmale Tachykardie (supraventrikulaer) |
Italian | Tachicardia parossistica (sopraventricolare), Tachicardia parossistica sopraventricolare |
Portuguese | Taquicardia supraventricular paroxística |
Spanish | Taquicardia supraventricular paroxística, Taquicardia paroxística (supraventricular), taquicardia paroxística supraventricular, SAI (trastorno), taquicardia paroxística supraventricular, SAI, taquicardia supraventricular paroxística (trastorno), taquicardia supraventricular paroxística |
Japanese | 発作性頻脈(上室性), 発作性上室性頻脈, ホッサセイヒンミャクジョウシツセイ, ホッサセイジョウシツセイヒンミャク |
Czech | Paroxysmální tachykardie (supraventrikulární), Paroxysmální supraventrikulární tachykardie |
Hungarian | Paroxysmalis supraventricularis tachycardia, Paroxysmalis tachycardia (supraventricularis) |
Ontology: Supraventricular tachycardia (C0039240)
Definition (NCI) | A disorder characterized by an electrocardiographic finding of a tachycardia which does not originate in the ventricles or His Purkinje system. There is an abnormally high heart rate and QRS complexes are typically narrow, but aberration or preexcitation may be present. (CDISC) |
Definition (NCI_CTCAE) | A disorder characterized by a dysrhythmia with a heart rate greater than 100 beats per minute that originates above the ventricles. |
Definition (MSH) | A generic expression for any tachycardia that originates above the BUNDLE OF HIS. |
Concepts | Disease or Syndrome (T047) |
MSH | D013617 |
ICD10 | I47.1 |
SnomedCT | 195104006, 266305002, 155363003, 6456007 |
LNC | LA17100-1 |
English | Supraventricular Tachycardias, Tachycardia, Supraventricular, Tachycardias, Supraventricular, SVT, TACHYCARDIA SUPRAVENTRICULAR, Supraventric. tachycardia NOS, Supraventricular tachycardia NOS, SVT - Supraventricular tachy, supraventricular tachycardia (diagnosis), supraventricular tachycardia, Tachycardia supraventricular, Tachycardia, Supraventricular [Disease/Finding], tachycardia supraventricular, supraventricular tachycardias, Supraventricular tachycardia (SVtach), Supraventricular tachycardia NOS (disorder), SVT - Supraventricular tachycardia, Supraventricular tachycardia (disorder), supraventricular; tachycardia, tachycardia; supraventricular, Supraventricular tachycardia, NOS, Supraventricular tachycardia, Supraventricular Tachycardia |
French | TACHYCARDIE SUPRAVENTRICULAIRE, TSV, Tachycardie supraventriculaire, Tachycardie supra-ventriculaire |
Portuguese | TAQUICARDIA SUPRAVENTRICULAR, Taquicardia supraventricular, Taquicardia Supraventricular |
Spanish | TAQUICARDIA SUPRAVENTRICULAR, TSV, taquicardia supraventricular, SAI (trastorno), taquicardia supraventricular, SAI, taquicardia supraventricular (trastorno), taquicardia supraventricular, Taquicardia supraventricular, Taquicardia Supraventricular |
Dutch | tachycardie supraventriculair, SVT, supraventriculair; tachycardie, tachycardie; supraventriculair, supraventriculaire tachycardie, Supraventriculaire tachycardie, Tachycardie, supraventriculaire |
German | SVT, Supraventrikulaere Tachykardie, TACHYKARDIE SUPRAVENTRIKULAER, Tachykardie supraventrikulaer, Supraventrikuläre Tachykardie, Tachykardie, supraventrikuläre |
Japanese | 上室性頻脈, ジョウシツセイヒンミャク |
Swedish | Takykardi, supraventrikulär |
Finnish | Supraventrikulaarinen takykardia |
Russian | TAKHIKARDIIA SUPRAVENTRIKULIARNAIA, TAKHIKARDIIA NADZHELUDOCHKOVAIA, ТАХИКАРДИЯ НАДЖЕЛУДОЧКОВАЯ, ТАХИКАРДИЯ СУПРАВЕНТРИКУЛЯРНАЯ |
Czech | SVT, Tachykardie supraventrikulární, Supraventrikulární tachykardie, supraventrikulární tachykardie, tachykardie supraventrikulární, supraventrikulární tachyarytmie |
Korean | 심실상성 빠른맥 |
Polish | Svt, Tachykardia nadkomorowa, Częstoskurcz nadkomorowy |
Hungarian | SVT, Tachycardia, supraventricularis, Supraventricularis tachycardia |
Norwegian | Supraventrikulær takykardi |
Italian | Tachicardia sopraventricolare |