Supraventricular tachycardia (SVT): The Daily PANCE Blueprint

Home Supraventricular tachycardia (SVT): The Daily PANCE Blueprint

Supraventricular tachycardia (SVT): The Daily PANCE Blueprint

A 35-year-old female presents to the emergency department with sudden-onset palpitations, lightheadedness, and mild shortness of breath. She denies chest pain or syncope. On physical examination, her blood pressure is 128/76 mmHg, heart rate is 180 bpm, and respirations are 18/min. Her 12-lead ECG shows a narrow complex tachycardia consistent with supraventricular tachycardia (SVT). She remains stable, alert, and oriented. Which of the following is the initial treatment of choice for this patient?

A. Direct current cardioversion
B. Intravenous adenosine
C. Intravenous diltiazem
D. Oral metoprolol
E. Vagal maneuvers

Answer and topic summary

The answer is E. Vagal maneuvers

The first-line treatment for stable patients with SVT is vagal maneuvers, which are simple, non-invasive techniques that increase vagal tone, slow AV node conduction, and can often terminate the arrhythmia. Common maneuvers include the Valsalva maneuver and carotid sinus massage. Vagal maneuvers are effective in 20-40% of cases and should always be attempted before moving to pharmacologic treatments.

In cases where vagal maneuvers fail, adenosine is the next step, as it temporarily blocks AV node conduction, effectively treating AVNRT (a common cause of SVT).

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Conduction Disorders (PEARLS) ⇒ Paroxysmal supraventricular tachycardia

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