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AVNRT

Paroxysmal Supraventricular Tachycardia

Sun, 04/12/2015 - 13:59 -- Dawn

This ECG is from a man in his 60's who is experiencing chest discomfort and palpitations.  The onset of the rapid heart rate and the symptoms was sudden, while he was at rest.  The rate did not slow when he was placed on oxygen, given IV fluids, and rested further

ECG Basics: Paroxysmal Supraventricular Tachycardia Treated With Adenosine

Sun, 12/28/2014 - 17:43 -- Dawn

This series of ECG rhythm strips shows a paroxysmal supraventricular tachycardia successfully treated with adenosine.  The patient was complaining of a rapid heart rate and palpitations, but was hemodynamically stable.  It is not known whether any parasympathetic stimulation, such as a Valsalva maneuver or carotid sinus massage, was used initially.   

ECG Basics: Paroxysmal Supraventricular Tachycardia

Fri, 11/21/2014 - 21:07 -- Dawn

This two-lead rhythm strip clearly shows the transition from normal sinus rhythm to a paroxysmal supraventricular rhythm.  In this case, the arrhythmia is AV nodal reentrant tachycardia, AVNRT.  The rate of the first rhythm, NSR, is around 75 per minute.  The fourth beat on the strip is a PAC which initiates the paroxysm of tachycardia lasting 12 beats.  The arrhythmia terminates spontaneously at that point.  The tachycardia rate is about 150/min.

Supraventricular Tachycardia

Thu, 01/02/2014 - 13:36 -- Dawn

This example of supraventricular tachycardia is from a 51-year-old woman who presented to the Emergency Dept. with a complaint of palpitations.  We do not have any more clinical information for her.  We know this tachycardia is supraventricular because the QRS complexes are narrow.  The term, "supraventricular tachycardia", or "SVT" actually describes many different rhythms with many different mechanisms and causes.  It would help a great deal to see the beginning (or end) of this rhythm to determine if the onset was sudden (paroxysmal) - or gradual.

ECG Basics: Supraventricular Tachycardia

Fri, 05/17/2013 - 22:20 -- Dawn

This strip is from a patient who experienced a sudden onset of palpitations and rapid pulse while at rest.  It shows a narrow-complex tachycardia, specifically a paroxysmal supraventricular tachycardia.  The subject of supraventricular tachycardias is a fascinating one, and is covered extensively throughout this website.  The mechanisms of SVT are many, and can be complex for the beginning student to understand.  Search the search terms on the left side of the page for entries from ASK the EXPERT and JASON's BLOG for more advanced information about SVT.

How do you teach the concept of reentry in PSVT to students with only a basic understanding of dysrhythmias?

Sun, 03/04/2012 - 02:13 -- Dawn

Our expert today is Dr. Ken Grauer. He is a frequent contributer to the ECG Guru.

 

KEN GRAUER, MD is Professor Emeritus (Dept. Community Health/Family Medicine, College of Medicine, University of Florida in Gainesville).
Dr. Grauer has been a leading family physician educator for over 30 years. During that time he has published (as principal author) more than 10 books and numerous study aids on the topics of ECG interpretation, cardiac arrhythmias, and ACLS (including an ongoing Educational ECG Blog.

 
Answer:
PSVT is a reentry tachycardia. This arrhythmia carries many names, one of which is AVNRT = AV Nodal Reentry Tachycardia - recognizing that in the vast majority of cases, there is reentry occurring in or around the AV node. The AV node is not a homogeneous structure - instead functionally (and anatomically on a microscopic level) - there are 2 basic pathways. One of these conducts "fast" - and the other "slower". Conduction preferentially goes down the "fast" pathway (thereby 'blocking' and preventing conduction down the slow pathway). But if for any reason (like a PAC) the fast pathway is "blocked" - then conduction of the impulse will have to go down the "slow" pathway. If the timing is just right - conditions may be set up that allow "reentry" within the AV node - with the impulse going down the slow pathway and up the fast pathway. Less commonly, reentry within the AV node may be set up in which the impulse goes down the fast pathway and back up the slow pathway.

 

Think of the phenomenon of reentry as comparable to the situation when 50 young children are all holding hands and running around in a circle while holding hands. All it takes is for one disgruntled person to stick out their leg - and ALL 50 of the children who are holding hands will fall down. So it is with reentry - it is a circuit that is set up by fortuitous circumstances of conduction speed, refractory period duration, and usually a precipitating premature impulse. How do we treat AV Nodal Reentry Tachycardia (PSVT)? Either by vagal maneuvers or medication such as adenosine, diltiazem/verapamil, or beta-blockers - ALL of which at least transiently alter conduction properties within a portion of the AV node. Just like the disgruntled citizen who stuck out their leg and tripped up all 50 children - all it takes is brief alteration/interruption of the conduction circuit (by meds or vagal maneuver) to terminate an AV Nodal Reentry Tachycardia.

 

Simplistic illustration of the concept of reentry appears in the Figure below (excerpted from pp 567-574 of Grauer K, Cavallaro D: ACLS: Comprehensive Review [Vol 2] - 3rd Edition, Mosby Lifeline, St. Louis - 1993). For a more detailed look at reentry - visit: https://www.kg-ekgpress.com/reentry-svt/ - where you can download a pdf of the above 7 pages.

 

Ken Grauer, MD (ekgpress@mac.com)

 

 

Exerpted from pp 567-574 of Grauer  K, Cavallaro D: ACLS: Comprehensive Review (Vol. 2) - 3rd Edition, Mosby Lifeline, St. Louis - 1993.

 

 

 

 

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