Supraventricular Tachycardias (SVTs)

*** In Progress ***
Brandon Fainstad, MD


OBJECTIVES
1. Characterize the electrophysiology of the eight supraventricular tachycardias.
2. Differentiate the supraventricular tachycardias based on regularity and ‘P’ wave morphology.
3. Identify the best step acute management for each rhythm.


TEACHING INSTRUCTIONS


PRINTOUTS
1. Learner Handout
2. Practice ECGs


INTERACTIVE BOARD FOR LEARNING/PREPARING


INTERACTIVE BOARD FOR PRESENTING


PRACTICE CASES
*See “Print outs” above for printable version


TAKE HOME POINTS

  1. Tachycardia is due to either increased automaticity of a pacemaker (nodal or ectopic) or a re-entry circuit. Re-entry circuits are generally faster.
  2. There are only 8 SVTs which are distinguished by regular vs. irregular rhythm and the presence or morphology of the p wave.
  3. Hemodynamically stable SVTs are acutely managed one of 3 ways:
    1. Address underlying disease (for sinus tach, atrial tach, junctional tach and multi-atrial tach)
    2. Resolve the re-entry circuit by interrupting AV conduction with vagal maneuvers or adenosine (for AVnRT and AVRT)
    3. Rate control with AV nodal blockers (for afib and aflutter)

REFERENCES

Nelson, William Paul, Henry J. L. Marriott, and Douglas D. Schocken. Concepts and Cautions in Electrocardiography. Northglenn, CO: MedInfo Inc., 2007.