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Potentially life-threatening emergency
Paroxysmal supraventricular tachycardia
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Paroxysmal supraventricular tachycardia

Contributors: Navya Akula MD, Ryan Hoefen MD, PhD
Other Resources UpToDate PubMed

Synopsis

Paroxysmal supraventricular tachycardia (paroxysmal SVT or PSVT) is a broad category of arrhythmias that originate in the atria or atrioventricular junction and occur episodically with a rapid rate (greater than 100 beats per minute [bpm]) with sudden onset and sudden termination. The QRS complex is usually narrow, although a wide QRS complex may occur if there is an underlying electrical conduction abnormality.

PSVT can be classified by origin and rhythm. Those with a regular rhythm originating in the atrium include sinus tachycardia (ST), inappropriate sinus tachycardia (IST), sinoatrial nodal reentrant tachycardia (SANRT), and atrioventricular reentrant tachycardia (AVRT). Irregular rhythms of atrial origin include atrial fibrillation and multifocal atrial tachycardia. Atrial flutter may be regular or irregular depending on the pattern of consistency of conduction from the atrium to ventricle. Regular rhythms originating from the atrioventricular node include junctional tachycardia (JT) and atrioventricular nodal reentrant tachycardia (AVNRT).

PSVT can occur in all age groups. Atrial fibrillation is the most common form of PSVT with the highest incidence and prevalence. The risk is doubled in women and increases with age.

PSVT can occur after an initial insult such as myocardial infarction, rheumatic heart disease, mitral valve prolapse, respiratory disease (chronic lung diseases, pneumonia, pulmonary embolism, or hypoxemia), myocarditis, pericarditis, structural heart disease, and hyperthyroidism. Drugs such as caffeine, nicotine, atropine, adenosine, cocaine, amphetamines, alcohol, digoxin, and ecstasy are known to cause PSVT.

The underlying pathophysiology often includes a reentry circuit in the heart or triggered, enhanced, or abnormal automaticity.

Clinical presentation may include severe palpitations, diaphoresis, dizziness, polyuria, syncope or near syncope, nausea, shortness of breath, pain or discomfort in the back, neck, or chest, anxiety, and/or fatigue, although some patients are asymptomatic. Patients with known coronary artery disease or structural heart disease may present with chest pain or decompensated heart failure. Persistent or incessant PSVT can cause tachycardia-induced cardiomyopathy, resulting in new-onset heart failure.

Codes

ICD10CM:
I47.1 – Supraventricular tachycardia

SNOMEDCT:
67198005 – Paroxysmal supraventricular tachycardia

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:05/17/2021
Last Updated:05/23/2021
Copyright © 2021 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Paroxysmal supraventricular tachycardia
Paroxysmal supraventricular tachycardia : Chest pain, Dizziness, Heart palpitations, Polyuria, Syncope, Dyspnea, Presyncope, HR increased
Copyright © 2021 VisualDx®. All rights reserved.