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    SVT

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    Akbar Iskandar
    Mr. AL, a 33-year-old male, was admitted to the hospital with shortness of breath that had lasted four days. His medical history included hypertension and tuberculosis. A physical exam found an irregular pulse of 160 beats per minute. Additional testing showed supraventricular tachycardia and active tuberculosis. He was diagnosed with supraventricular tachycardia and tuberculosis. Treatment included medications, oxygen, and catheter ablation is the preferred long-term treatment for supraventricular tachycardia.

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    SVT

    Uploaded by

    Akbar Iskandar
    31 views31 pages
    Mr. AL, a 33-year-old male, was admitted to the hospital with shortness of breath that had lasted four days. His medical history included hypertension and tuberculosis. A physical exam found an irregular pulse of 160 beats per minute. Additional testing showed supraventricular tachycardia and active tuberculosis. He was diagnosed with supraventricular tachycardia and tuberculosis. Treatment included medications, oxygen, and catheter ablation is the preferred long-term treatment for supraventricular tachycardia.

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    SVT

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    Mr. AL, a 33-year-old male, was admitted to the hospital with shortness of breath that had lasted four days. His medical history included hypertension and tuberculosis. A physical exam found an irregular pulse of 160 beats per minute. Additional testing showed supraventricular tachycardia and active tuberculosis. He was diagnosed with supraventricular tachycardia and tuberculosis. Treatment included medications, oxygen, and catheter ablation is the preferred long-term treatment for supraventricular tachycardia.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    31 views31 pages

    SVT

    Uploaded by

    Akbar Iskandar
    Mr. AL, a 33-year-old male, was admitted to the hospital with shortness of breath that had lasted four days. His medical history included hypertension and tuberculosis. A physical exam found an irregular pulse of 160 beats per minute. Additional testing showed supraventricular tachycardia and active tuberculosis. He was diagnosed with supraventricular tachycardia and tuberculosis. Treatment included medications, oxygen, and catheter ablation is the preferred long-term treatment for supraventricular tachycardia.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    of 31

    Supraventricular

    Tachycardia
    Presenter: Ahmad Randy
    Supervisor: dr. Pendrik Tandean, Sp.PD

    PATIENT IDENTITY
    Name : Mr. AL
    No.MR : 209.769
    Age
    : 33 y.o
    Gender
    : Male
    Address
    : BTN Pepabri, blok E No.
    1 Makassar
    Date of admittance : 25th March 2009

    HISTORY
    Chief complaint : out of breath
    It has been felt since four day continuously.
    Oppressed increases if the patient has been
    cough. There is cough since approximately 1
    year ago. Mucus there are white colour, blood is
    not exist, bleeding cough history is exist. Chest
    pain is exist, once in a while if coughs it firm.
    Chest pain is not disseminates to other arm or
    other area. His heart felt palpitates. Nausea and
    vomit is not exist, heart burn is not exist. Fever
    is not exist. Body weight declines in a few this
    last month. Urinate & defecate were normal.

    PAST MEDICAL HISTORY


    Hypertension (-)
    Diabetes mellitus (-)
    Cardiovascular disease (SVT on

    January 2009)
    Pulmonary disease (TB on treatment)

    PHYSICAL EXAMINATION
    Status present : Moderate-illness/Underweight/Composmentis
    Vital Sign :

    Blood pressure
    : 120/80mmHg
    Pulse
    : 160x/min
    Inspiratory rate
    : 32x/min
    Body temperature : 36.5oC

    Head Examination :

    Eyes : there was anemis, no icterus


    Lip : no cyanosis
    Neck : JVP R-2 cmH2O, there were no mass & tenderness

    Thoracal Examination :

    Inspection
    : Symmetric
    Palpation : No mass; no tenderness
    Percussion
    : Sonor
    Auscultation
    : Breath Sound : bronchovesicular
    Additional sound : ronchi +/+ apeks; wheezing -/-

    PHYSICAL EXAMINATION
    Cardiac Examination :

    Inspection
    Palpation
    Percussion
    Auscultation

    : ictus cordis was invisible


    : ictus cordis was impalpable
    : deaf
    : sound of I/II heart sound; no murmur

    Abdominal Examination :

    Inspection
    Palpation
    Percussion
    Auscultation

    : normal
    : no mass; no tenderness
    : tympani
    : peristaltic sound (+); normal

    Extremities : swelling (-)

    ADDITIONAL EXAMINATION
    Laboratory test

    Random glucose : 95 mg/dl

    Complete blood
    WBC
    RBC
    HGB
    HCT
    PLT

    : 8,8 x 103 /mm3 ()


    : 4,24x 106 /mm3
    : 10,9 g/dl
    : 35.8 %
    : 352x 103 /ul

    : 114 mmol/l ( )
    : 4,4 mmol/l
    : 106 mmol/l ( )

    Cardiac enzymes
    CK
    CKMB

    SGOT

    : 18 U/l

    SGPT

    : 15 U/l

    Cholesterol total : 133 mg/dl


    Cholesterol HDL: 62 mg/dl
    Cholesterol LDL : 81 mg/dl

    Blood electrolytes
    Natrium
    Kalium
    Chloride

    Blood chemistry

    : 73
    : 22

    Triglyseride

    : 91 mg/dl

    Ureum

    : 12 mg/dl

    Creatinin

    : 0,26 mg/dl

    ELECTROCARDIOGRAPHY
    Interpretation
    :
    - Sinus
    takikardi
    - Normoaxis
    - None Pwave (II, III,
    aVF)

    Echocardiografi
    Interpretation:
    - Within normal

    CHEST X-RAY
    Interpretation:
    - KP duplex lama
    aktif
    - efusi pleura
    dextra

    DIAGNOSE
    - Supraventricular tachycardia
    - TB pulmo

    - Dietary high callory high protein


    - IVFD RL:D 5% 1:1 20 dpm
    - Bed rest
    - O2 4-6 L/i
    - Alprazolam 0,5mg 0-0-1
    - Cordaron 450mg/24j/sp
    - Aspilet 80mg 0-1-0

    Discussio
    n

    Discussion
    Supraventricular tachycardia (svt) is any
    tachyaritmia that requires only atrial and/or
    atrioventricular (av) nodal tissue for its
    initiation and maintenance.
    The most common mechanism identified is
    reentry

    Reentry can be happen in:


    - SA node (sinus nodal reentrant tachycardia).
    Very rare
    - Atrium (atrial tachycardia)
    - AV node (AVNRT and AVRT)

    Sinus nodal reentrant tachycardia (SNRT)


    SNRT is due to reentry circuit, either in or
    near the sinus node. Therefore, it has an abrupt
    onset and offset. The heart rate is usually 100150x/I and ECG tracings usually demonstrate
    normal sinus P-wave morphology.

    SNRT

    The QRS complexes are narrow and regular. The patient's heart rate is
    approximately 135 beats per minute. P waves are normal in morphology

    Atrial Tachycardia
    Atrial tachycardia is an arrhythmia originating
    in the atrial myocardium. The heart rate is
    regular and is usually 120-250x/i.

    Atrial Tachycardia

    Atrial tachycardia. The patient's heart rate is 151 beats per minute. P waves are upright in lead
    V1

    AVNRT (AV nodal reentrant tachycardia)


    - The most common cause of PSVT is AVNRT.
    AVNRT is diagnosed in 50-60% of patients who
    present with regular narrow QRS tachyarrhythmia.
    - The heart rate is 150-250 bpm and is typically quite
    regular
    - AVNRT may occur in healthy, young individuals, and
    it occurs most commonly in women. Most patients
    do not have structural heart disease. However,
    occasionally these individuals may have an
    underlying heart condition such as rheumatic heart
    disease, pericarditis, myocardial infarction or mitral
    valve prolapse

    AVNRT

    The patient's heart rate is approximately 146 beats per minute with a normal axis. Note the
    pseudo S waves in leads II, III, and aVF. Also note the pseudo R' waves in V1 and aVR.
    These deflections represent retrograde atrial activation.

    - The AV node is functionally divided into 2 longitudinal

    pathways that form the reentrant circuit. In the majority of


    patients, during AVNRT, antegrade conduction occurs to the
    ventricle over the slow (alpha) pathway and retrograde
    conduction occurs over the fast (beta) pathway
    - The tachycardia is initiated when an appropriately timed atrial

    premature complex is blocked in the fast pathway (longer


    period) and conducts in the slow pathway (shorter period).
    - While the impulse conducts to the ventricle in the slow

    pathway (antegrade conduction), the fast pathway recovers so


    that the impulse can conduct retrograde up the fast pathway to
    the atrium and the atrial end of the slow pathway (retrograde
    conduction).

    AV reentrant tachycardia (AVRT)


    - AVRT is the second most common form of SVT. The

    incidence rate of AVRT in the general population is


    0.1-0.3%. AVRT is more common in males than in
    females
    - in AVRT, 1 or more accessory pathways connect the
    atria and the ventricles. The accessory pathways may
    conduct impulses in an anterograde manner, a
    retrograde manner, or both

    Sex:
    Most series of catheter ablation reflect a higher
    proportion of female patients with AVNRT than
    male patients. In a population-based study, the
    risk of developing SVT was twice as high in
    women compared to men.
    Age:
    The prevalence of SVT increases with age.

    Clinical finding:
    Common presenting symptoms of SVT and their frequency
    rates are as follows:
    Palpitation (> 96%)
    Dizziness (75%)
    Shortness of breath (47%)
    Syncope (20%)
    Chest pain (35%)
    Fatigue (23%)
    Diaphoresis (17%)
    Nausea (13%)

    Physical finding:
    Generally limited to cardiovascular and respiratory

    systems. Patients often appear quite distressed.


    Tachycardia may be the only finding in patients who
    are otherwise healthy.
    Patients who have limited hemodynamic reserve may
    be tachypneic and hypotensive. Crackles may be
    auscultated secondary to heart failure. An S3 may be
    present, and large jugular venous pulsations may also
    be visualized.

    Management:
    - Vagal maneuver (cough, vomit)
    - Valsalva maneuver
    - Compressing sinus carotis

    Short-term medical management


    Short-term management involves intravenous

    adenosine or calcium channel blockers. Adenosine is a


    short-acting drug that blocks AV node conduction; it
    terminates 90% of tachycardias due to AVNRT or
    AVRT.
    Other alternatives include calcium channel blockers
    like verapamil, diltiazem or beta-blockers like
    metoprolol or esmolol. Verapamil is a calcium channel
    blocker that also has AV blocking properties.

    Long-term medical management


    - Patients with SVT may initially be treated with

    calcium channel blockers, digoxin, and/or betablockers. Class IA, IC, or III antiarrhythmic agents
    are used less frequently because of the success of
    radiofrequency catheter ablation
    - Radiofrequency ablation is cost-effective for patients
    who have frequent episodes of SVT

    Terima
    Kasih

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