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Author: Admin | 2025-04-28
On ECG, respectively.Occasionally, SVTs can present with wide QRS, as in case of SVT with bundle-branch block and SVT with AV conduction through an accessory pathway.37SVTs include a wide range of arrhythmias originating in the atrium of the atrioventricular node that can be divided into two groups based on the rhythm pattern.38,39:1. Regular SVTs:Atrial flutterAtrioventricular recurrent tachycardiaAtrioventricular recurrent tachycardiaAtrial tachycardiaSinus tachycardia2. Irregular SVTs:Atrial fibrillationAtrial tachycardia with variable blockAtrial flutter with variable blockMultifocal atrial tachycardiaFrequent premature atrial blocSVT: Presentation and DiagnosisSVTs can be symptomatic or asymptomatic (identified by surface ECG). ECG documentation is required for the diagnosis of SVT.38,40 Patients with symptomatic SVTs present with palpitations, dyspnea, fatigue, chest pain or tightness, poor effort tolerance, dizziness, syncope, and troubled sleeping. In the case of hemodynamically unstable atrial fibrillation, the following conditions may be observed: syncope, symptomatic hypotension, acute heart failure, pulmonary edema, myocardial ischemia, and cardiogenic shock.40Atrial fibrillation is a supraventricular tachyarrhythmia with uncoordinated atrial electrical activation and consequently ineffective atrial contraction.40 It is the most common type of cardiac arrhythmia.41 Atrial fibrillation is diagnosed based on irregular R-R intervals in the absence of p-waves and irregular atrial activation on a 12-lead ECG recording or a single-lead ECG tracing of > 30 seconds.40 SVT: Diagnostic WorkupDiagnostic workup for all SVT patients should include a physical exam, complete medical history and concurrent conditions, 12-lead ECG to establish diagnosis and asses ventricular rate, and the identification of ischemia, structural defects, and conductivity problems. Complete blood work (full blood count, electrolytes, thyroid, and kidney function) and transthoracic echocardiogram should be part of diagnostic workup.Selected atrial fibrillation patients should be evaluated for the presence of pulmonary embolisms and examined by transesophageal echocardiogram to evaluate for atrial thrombus.40SVT: Differential DiagnosisAtrioventricular nodal reentry tachycardiaMultifocal atrial tachycardiaParoxysmal supraventricular tachycardiaWolff-Parkinson-White SyndromeRegular tachycardia:If Yes:No Visible P waves AVNRTVisible P waves:Atrial rate greater than ventricular rate = Atrial flutter or Atrial tachycardiaAtrial rate not greater than ventricular rate:Long RP (RP longer than PR) = Atrial tachycardia, PJRT, Atypical AVNTShort RP interval – Less than 70 ms = AVNRTShort RP interval – More than 70 ms = AVRT, AVNRT, ATIf No:Atrial fibrillation,
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