Paroxysmal supraventricular

Compare and contrast the risk factors for and the features, mechanisms, etiologies, symptoms, and goals of therapy of (1) sinus bradycardia (2) atrioventricular (AV) nodal blockade (3) atrial fibrillation (AF) (4) paroxysmal supraventricular tachycardia (PSVT) ... 

Adenosine is the drug of choice for termination of paroxysmal supraventricular tachycardia. 

Paroxysmal supraventricular tachycardia (PSVT) is a term that refers to a number of arrhythmias that occur above the ventricles and that require atrial or AV nodal tissue for initiation and maintenance.32 The most common of these arrhythmias is... 

O Paroxysmal supraventricular tachycardia is caused by reentry that includes the AV node as a part of the reentrant circuit. Typically, electrical impulses travel forward (antegrade) down the AV node and then travel back up the AV node (retrograde) in a repetitive circuit. In some patients, the retrograde conduction pathway of the reentrant circuit may exist in extra-AV nodal tissue adjacent to the AV node. One of these pathways usually conducts impulses rapidly, while the other usually conducts impulses slowly. Most commonly, during PSVT the impulse conducts antegrade through the slow... 

TABLE 6-9. Drugs for Termination of Paroxysmal Supraventricular Tachycardia... 

FIGURE 6-10. Decision algorithm for termination of paroxysmal supraventricular tachycardia. HF, heart failure LVEF, left ventricular ejection fraction PSVT, paroxysmal supraventricular tachycardia. (Algorithm adapted with permission from Tisdale JE, Moser LR. Tachyarrhythmias. In Mueller BA, Bertch KE,... 

PST Paroxysmal supraventricular tachycardia S3 Third heart sound (ventricular gallop)... 

PSVT Paroxysmal supraventricular tachycardia S4 Fourth heart sound (atrial gallop)... 

Common supraventricular tachycardias requiring drug treatment are atrial fibrillation (AF) or atrial flutter, paroxysmal supraventricular tachycardia (PSVT), and automatic atrial tachycardias. Other common supraventricular arrhythmias that usually do not require drug therapy are not discussed in this chapter (e.g., premature atrial complexes, wandering atrial pacemaker, sinus arrhythmia, sinus tachycardia). 

AF, atrial fibrillation HF, heart failure 10, intraosseous PSVT, paroxysmal supraventricular tachycardia VF, ventricular fibrillation VT, ventricular tachycardia. 

FIGURE 6-2. Algorithm for the treatment of acute (top portion) paroxysmal supraventricular tachycardia and chronic prevention of recurrences (bottom portion). Note For empiric bridge therapy prior to radiofrequency ablation procedures, calcium channel blockers (or other atrioventricular [AV] nodal blockers) should not be used if the patient has AV reentry with an accessory pathway. (AAD, antiarrhythmic drugs AF, atrial fibrillation AP, accessory pathway AVN, atrioventricular nodal AVNRT, atrioventricular nodal reentrant tachycardia AVRT, atrioventricular reentrant tachycardia DCC, direct-current cardioversion ECG, electrocardiographic monitoring EPS, electrophysiologic studies PRN, as needed VT, ventricular tachycardia.)... 

Phenylephrine is used in hypotension, paroxysmal supraventricular tachycardia, and shock. It is also used locally, particularly in the form of nasal spray, for relieving edema. Synonyms of this dmg are ahnefrine, degest, neoxedrin, metaoxedrin, and many others. 

Digitoxin is used for chronic cardiac insufficiency, tachyarrhythmia form of atrial fibrillation, paroxysmal ciliary arrhythmia, and paroxysmal supraventricular tachycaria. Synonyms of this drag are cardigin, cordalin, crystodigin, purodigin, and others. 

Verapamil is used for preventing angina pectoris attacks, arterial hypertension, and treating and preventing supraventricular arrhythmia (paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, extrasystole). Synonyms of this drug are isoptin, calan, fmoptin, falicard, manidone, and many others. 

Paroxysmal supraventricular tachycardias - 400 to 600 mg every 2 or 3 hours until the paroxysm is terminated. 

Atrial fibrillation For the prevention of paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms and paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, and other supraventricular tachycardias of unspecified mechanism associated with disabling symptoms in patients without structural heart disease. 

Once the arrhythmia is controlled, it may be possible to reduce the dose, as necessary, to minimize side effects or effects on conduction. PSVT and PAF The recommended starting dose is 50 mg every 12 hours. Doses may be increased in increments of 50 mg twice daily every 4 days until efficacy is achieved. For PAF patients, a substantial increase in efficacy without a substantial increase in discontinuation for adverse experiences may be achieved by increasing the flecainide dose from 50 to 100 mg twice/day. The maximum recommended dose for patients with paroxysmal supraventricular arrhythmias is 300 mg/day. 

PRN as needed (Latin pro re nata ) PSVT paroxysmal supraventricular tachycardia pt patient... 

Adenosine reduces heart rate and AV conduction, although it is not a calcium antagonist. It is administered intravenously for the acute treatment of paroxysmal supraventricular tachycardia. Adenosine displays a rapid onset and short duration of action. Apart from its antiarrhythmic activity it is also a vasodilator, in particular in the coronary system. 

Diltiazem Paroxysmal supraventricular tachycardia Atrial fibrillation... 

The prominent depressant action of verapamil and diltiazem at the SA and A-V nodes finds use in specific arrhythmias. They are of proven efficacy in acute control and long-term management of paroxysmal supraventricular tachycardia (see Chapter 16).Their ability to inhibit conduction at the A-V node is employed in protecting ventricles from atrial tachyarrhythmias, often in combination with digitalis or propranolol. 

Unlabeled Uses Control of hemodynamicallystableventriculartachycardia, control of rapid ventricular rate due to accessory pathway conduction in preexcited atrial arrhythmias, conversion of atrial fibrillation to normal sinus rhythm, in cardiac arrest with persistent ventricular tachycardia or ventricular fibrillation, paroxysmal supraventricular tachycardia, polymorphic ventricular tachycardia or wide complex tachycardia of uncertain origin, prevention of postoperative atrial fibrillation... 

Temporary control of rapid ventricular rate in atrial flBrillation or flutter, rapid conversion of paroxysmal supraventricular tachycardia to normal sinus rhythm IV push Initially, 0.25 mg/kg actual body weight over 2 min. May repeat in 15 min at dose of 0.35 mg/kg actual body weight. Subsequent doses individualized. IV Infusion / fter initial bolus injection, may begin infusion at 5-10 mg/hr may increase by 5 mg/hr up to a maximum of 15 mg/hr. Infusion duration should not exceed 24 hr. 

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