What's Your Diagnosis? Supraventricular Tachydysrhythmias in the Emergency Department

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last month’s case on Ventilator Management of Adult Patients in the Emergency Department right.

Case Presentation: Supraventricular Tachydysrhythmias in the Emergency Department

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.

Case Conclusion

The 31-year-old woman with palpitations was crying while talking to her husband about how she was dreading that ?awful adenosine.? You reassured her and said, ?Don?t worry, there are some other things we can try.? You performed the vagal maneuver with postural modification as described in the recent REVERT trial, but unfortunately, it was not successful. Afterwards, you explained how you wanted to attempt using a CCB. The patient consented, and you ordered diltiazem 0.25 mg/kg IV over 2 minutes, with close monitoring for hypotension. The intervention was successful, and the patient was ultimately discharged.

Click to review this Emergency Medicine Practice Issue, Supraventricular Tachydysrhythmias in the

Last Updated on January 26, 2023

EB Medicine

5 thoughts on “What’s Your Diagnosis? Supraventricular Tachydysrhythmias in the Emergency Department”

Start ABC with the pt and try carotid massage
valsalva maneuver
If no benefit
Try verapamil 5mg in 100 cc N/S

Carotid sinus pressure (Carotid sinus message) CSP CSM I’ve had over 75% success with this technique over the years. (No adverse consequences eg the feared CVA. Simple valsalva maneuvers also work. Ice water NEVER works.