Question about SVT and VTach.

[SC Bird]

Was doing some downtime forum reading and saw this from a rhythm thread.

There is debate among cardiologist that determining a SVT vs. VT, some declare that very fast rates>180 are really V-tach in disguise..(with a narrow QRS).. The answer is still out.. That is why most still treat tachycardiac rhythm per QRS configuration.

Just curious if anyone had any thoughts or literature so that I could read up on this debate. (Hoping no one is just going to refer me to google. )

Any info would be appreciated...just reading up on SVT (and we cover ventricular rhythms in ECG on Tuesday).

BTW, here's a strip from an internship on Monday. Pt. entered this rhythm during chemo treatment. Nurses at office instructed pt. to attempt Valsalva maneuvers then administered 12 mg adenosine, then 6 mg before they ran out...then they called 911. Pt. was asymptomatic. C/C of tightness in chest. 1 minute transport to ER across the street.

-Matt

 

[MSDeltaFlt]

Without the use of a 12 lead, there is very little to go on.

 

[Ridryder911]

Ditto what MSDeltaFlt said. With Chemo expect the patient to be dehydrated and electrolytes to be screwed up. Although, initially it appears to be SVT.. too fast for V-tach as well as the QRS is not wide enough. Again, without a XII a true Dx. cannot be made.

R/r 911

 

[ncmedic309]

I also would like to see a 12-Lead EKG - with the strip provided - I'm going with SVT, most likely A-Flutter...

 

[Firemedic515]

Nurses at office instructed pt. to attempt Valsalva maneuvers then administered 12 mg adenosine, then 6 mg before they ran out...then they called 911.

12mg didn't convert it and they thought 6mg would do anything? Shouldn't they have tried 6 first and then went to 12 rapid IVP?

Amazing that this patient was essentially asymptomatic. How old was the patient? Were they able to convert the rhythm in the ER?

 

[SC Bird]

Ditto what MSDeltaFlt said. With Chemo expect the patient to be dehydrated and electrolytes to be screwed up. Although, initially it appears to be SVT.. too fast for V-tach as well as the QRS is not wide enough. Again, without a XII a true Dx. cannot be made.

R/r 911

Being the intern on the truck, I was wanting to give this guy the works (12 lead, adenosine had he been unstable, etc)...but preceptor said since we had a transport time of 1 min to the ER that we shouldn't waste any time.

Wish I had a 12 lead...

-Matt

 

[SC Bird]

12mg didn't convert it and they thought 6mg would do anything? Shouldn't they have tried 6 first and then went to 12 rapid IVP?

That left me scratching my head too....oh well....

Amazing that this patient was essentially asymptomatic. How old was the patient? Were they able to convert the rhythm in the ER?

I was pretty amazed as well. 55 y/o pt. with esophageal CA. Pt. able to speak in complete sentences, deny chest pain and SHOB, skin warm and moist. We walked in and he turned to me when I was talking to him and said, "I can just feel my heart racing. I've got a tightness in my chest as though I overexerted myself."

When we got him to the ER, we got another call about two minutes later. They had ordered a couple of drugs, were applying the pads, and were talking about possibly needing to sedate him if they had to shock him.

-Matt

 

[upstateemt]

My vote is SVT (in the absence of a 12 lead).

As a Cardiac Rehab Nurse I see some amazingly fast SVT's that are tolerated relatively well. Adenosine seems to not work about 50% of the time, or breaks the rhythm and it picks right back up.

 

[Ridryder911]

Here is your key, why Adenocard did not work..."entered this rhythm during chemo treatment"... Chemo can produce SVT for several reasons. First Chemo agents dehydrate patients very severe.

I had a similar patient that had a rate of 160-180 as well, and the other Paramedic wanted to give Adenocard, I would not allow him to do so. Again one needs to go to the etiology and cause, and tx the patient NOT the monitor!... I gave her a fluid bolus of about 500 and converted her.. she was dehydrated. As well remember, people on Chemo are very immuno deficient, meaning that they may be down on platelets, & RBC's as well..Remember, what RBC's do? That's right carry oxygen, so they are hypoxic induced arrythmia's... As well, I would be very interested if this was not a cytotoxic reaction... My late wife had one with only 1ml of chemo..Fortunately, I was beside her and was able to convince the nurse to tx. her rate went into the upper 100's as well her pressure dropped to 40/0 .. enough it ruptured the vessels in her scelra..

Main point.. patient symptomatic, treat the patient not the monitor! .. Although, be prepared!

R/r 911

 

[MSDeltaFlt]

Rid, I feel you. For some reason, I've never converted lethal rhythms with antiarrhythmics or electricity, except for cocaine induced SVT. If they were in SVT, the Adenocard would slow them down enough to see it was A-fib, and my ground service doesn't carry Cardizem. Other than that, I've converted both supravent and vent rhythms on O2, vagals, or fluid boluses. It's amazing.

 

[jedirye]

This was/is a great thread and that was some great information, RR, as well as others.

-rye