July 18, 2013

Image of the Day 21: AVNRT SVT reverted by IV Adenosine

40 years old lady with no known medical illness presented with palpitation in which she describe it as her heart is jumping out from the chest. Otherwise, no shortness of breath, no typical chest pain, no altered in consciousness.
On examination, patient is conscious and alert. vital signs are as follow, RR:20 b.p.m, PR: 160, afebrile, BP 115/79, GCS full.
First ECG shows narrow complex tachycardia with no visible P wave. It is regular rhythm with rate about 150 b.p.m. There is also present of right bundle branch block. Otherwise no acute ischemic changes.

A trial of carotid massage and valsalva maneuver yields negative result. In the absence of contraindication for adenosine, patient was decided for trial of IV adenosine.
Patient was managed in resuscitation bay with vital sign and cardiac monitoring attached to her. A large bore IV canulla attached to three way stopper was inserted at left ante cubital fossa. Patient was then counseled regarding complication of adenosine in which she may feel tightness of the chest, sense of heart stop beating, cardiac arrhythmia and asystole which require resuscitation. Intubation set with advanced cardiac life support set was prepared.
The three way catheter was connected to two syringe. One syringe consist of IV adenosine 6 mg   and another is consist of IV normal saline 20 cc. Then IV adenosine was pushed, followed by rapid bolus of IV normal saline 20cc with the hand was elevated above the heart level.
Cardiac monitors shows broad complex arrhythmia consist of multiple ectopic foci before it finally shows sinus rhythm. 

Repeated ECG shows Sinus rhythm with heart rate of 100 b.p.m, right bundle branch block and T inversion at lead III, V1 and V2

She was then admitted to CCU for close observation. 

Case of SVT in children

Paediatric Emergency Osce  [link]

 Answer: [link]

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