Paroxysmal Supraventricular Tachycardia

Paroxysmal Supraventricular Tachycardia General Information

Paroxysmal Supraventricular Tachycardia is considered a tachycardia or rapid rhythm of the patient’s heart in which the origin of the electrical signal can be considered either the atria or the atrial-ventricular node. Generally and by definition, these rhythms are produced and maintained by the heart’s sinoatrial node which is located in the atria or by the atrial-ventricular node. That is why the disease is considered to be triggered by these nodes which can cause rapid rhythms. There are several types of Paroxysmal Supraventricular Tachycardia, depending on the cause of the condition.

The sinoatrial type of the disease can be caused by certain factors such as sinus tachycardia, inappropriate sinus tachycardia or sinoatrial node reentrant tachycardia. The atrial type of the disease can be caused by the following factors: unifocal or multifocal atrial tachycardia, atrial fibrillation with rapid ventricular response, or atrial flutter with rapid ventricular response. The atrioventricular type of the disease can be caused by certain risk factors that can include atrioventricular nodal reentrant tachycardia or junctional ectopic tachycardia. The last type of the disease can develop suddenly and last for just several seconds, but there are also cases in which it can last for days. The patient can or can not experience signs and symptoms, depending on their hemodynamic reserve and heart rate. If Paroxysmal Supraventricular Tachycardia is not treated properly or not treated at all, it can progress causing severe complication which can include heart failure, pulmonary edema, myocardial ischemia, and myocardial infraction, especially due to poor left ventricular function.

Paroxysmal Supraventricular Tachycardia Symptoms

In most cases, the signs and symptoms caused by Paroxysmal Supraventricular Tachycardia can differ in severity and duration depending on the presence of structural heart disease and on the patient’s hemodynamic reserve. Patients who suffer from this kind of disease can experience mild or severe symptoms or chronic cardiopulmonary disorders. Usually, the most common signs and symptoms caused by the condition can include palpitations and dizziness, but there are also cases in which the patient can report chest discomfort caused by rapid heart rate, which can be easily subscribed with the termination of tachycardia.

There is a list of possible signs and symptoms that the patient can experience and can include tiredness, palpitations, weakness, and shortness of the breath, syncope, chest pain, fatigue, diaphoresis and nausea. Usually, the development of Paroxysmal Supraventricular Tachycardia can be staged as: time of onset, any triggers, certain episodes of arrhythmia and the previous treatment trial. In treating the condition the doctor should know the patient’s medical and cardiac history, but also a complete list of all medication that he took. In most cases, patients who are hemodynamically unstable must be resuscitated immediately using a procedure called cardio-version. It is recommended for a person who suffers from Paroxysmal Supraventricular Tachycardia to avoid dynamic activities such as exercising and driving due to the past episodes of syncope or near syncope. Patients who present limited hemodynamic reserves can be diagnosed as tachypneic and hypotensive. In these cases, the patient can experience crackles which can lead to heart failure and eventually to death.

Paroxysmal Supraventricular Tachycardia Treatment

In most cases, Paroxysmal Supraventricular Tachycardia can be diagnosed by only performing an EKG procedure. Usually, when the patient is suffering from this medical condition, his EKG diagram present the QRS complex as narrow, but there are cases in which the atrioventricular type of the disease, which also presents aberrant conduction, can produce a wider complex that can be similar to supra-ventricular type. It is very important for the doctor to determine precisely the type of disease the patient is suffering from, because they present different treatments and maintenance. The ventricular form of the disease must be treated properly, because it can easily degenerate to ventricular fibrillation and eventually to the death of the individual. Usually, Paroxysmal Supraventricular Tachycardia is not a life threatening condition but the episodes that can be present must be treated and prevented.

There are some treatment trials that can be applied to all types of the disease with impunity, but there are certain treatment options available to treat only one type of the different subtypes of the disease. The treatment for this disorder - Paroxysmal Supraventricular Tachycardia requires intimate knowledge of how and where it developed. The treatment can be divided in two major groups, depending on the involvement of the atrioventricular node. The cases in which the AV node is not involved, the first step is applying blocking maneuvers. These maneuvers cause increased atrioventricular node block, especially by activating the patient’s parasympathetic nervous system, controlled by the vagus nerve. The most common procedure applied in these cases is Vlasalva maneuver, which acts by increasing intra-thoracic pressure, which affects the pressure sensors or baro sensors that are located in the arch of the aorta. These effects can be achieved by working with the patients to hold their breath or holding their nose and blow out against it. There are cases in which by only drinking a glass of ice cold water can be effective. Doctors can also recommend pressing the bulb at the top of one of the carotid arteries located in the patient’s neck. These maneuvers should be done by trained staff, because if they are not done properly it can worsen the condition.

Another way to treat Paroxysmal Supraventricular Tachycardia is drug treatment. In most cases, doctors can prescribe Adenosine as main medicine in treating the disease, which acts by blocking the atrioventricular node. Usually, if the medicine is effective, doctors recommend a follow-up trial with Diltiazem, Verapamil and Metoprolol. If the patient presents the form of the condition that does not involve the atrioventricular node, the doctor can apply anti arrhythmic medicines such as Sotalol and Amiodarone. If the patient is pregnant, doctor can apply a treatment which consists in Metoprolol. There are cases in which either of these procedures is effective or the patient’s Paroxysmal Supraventricular Tachycardia is extremely unstable, a DC shock can be delivered to the chest, a procedure called synchronized cardio-version. This procedure is in most cases very efficient, but it is not recommended because it can cause severe side effects.