PSVT: The Daily PANCE Blueprint
A 32-year-old female presents to the ER with worsening shortness of breath and palpitations. Her vital signs are HR 180 bpm, BP 122/82 mmHg, RR 12 breaths/min, SpO2 95% on RA, and T 98.6F. Her EKG reveals a narrow complex tachycardia with a regular rhythm and no visible P waves. Which of the following is the preferred first-line treatment?
A. Metoprolol
B. Cardizem
C. Adenosine
D. Cardioversion
E. Start CPR
Answer and topic summary
The answer is C. Adenosine
Paroxysmal supraventricular tachycardia (PSVT) is defined by a sustained rapid rhythm that originates above the bundle of His; it is an umbrella term that includes atrioventricular nodal reentry tachycardia (AVNRT), atrioventricular reciprocating tachycardia & (AVRT). Clinical features include palpitations, light-headedness, chest discomfort, anxiety, dyspnea, or fatigue. Specific EKG findings depend on the type of PSVT, but typically it will demonstrate unidentifiable or inverted P waves with a regular rhythm above 100 beats per minute). Management for stable PSVTs includes vagal maneuvers, adenosine (first line), calcium channel blockers, beta-blockers, and even anti-arrhythmic (like amiodarone). Unstable PSVTs deserve electricity (i.e., synchronized cardioversion). The definitive treatment is catheter ablation (95% success rate).
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
Also covered as part of the HEREEOR, HEREEOR, and topic lists
