A hemodynamically unstable patient is noted to have supraventricular tachycardia. The most appropriate treatment is
A) Electrical synchronized cardioversion
B) Carotid massage
C) Adenosine
D) Verapamil
E) Digoxin
Answer and Discussion
The answer is A. Electrical synchronized cardioversion
Supraventricular tachycardia is characterized by a rapid regular rhythm with a narrow QRS complex and abnormal P waves. The heart rate is usually 100 to 200 bpm. Some patients may be asymptomatic; others may experience chest pain, palpitations, and shortness of breath.
Hemodynamically unstable patients with supraventricular tachycardia require immediate treatment with electrical synchronized cardioversion.
For those patients who are stable, vagal stimulation can be attempted with carotid massage (but not in patients with previous cerebrovascular accidents or carotid bruits), Valsalva’s maneuver, activation of the gag reflex, or placing a cold ice bag on the face.
If these measures are unsuccessful, medication including adenosine, verapamil, diltiazem, or a β-
blocker, can be used.
Untreated supraventricular tachycardia may lead to heart failure.
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