کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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6084729 | 1589115 | 2016 | 5 صفحه PDF | دانلود رایگان |
BackgroundSymptomatic tachycardia is a common admission diagnosis in the emergency department (ED). This can be a life-threatening condition and requires immediate attention. Supraventricular tachycardia (SVT) is commonly treated with adenosine, and successful treatment is limited to atrioventricular (AV) node-dependent SVTs as adenosine causes a transient heart block. However, there are limited data available for instances when the recommended dosing regimen (6Â mg, 12Â mg, 12Â mg) fails to terminate SVT.Case ReportA 33-year old man was evaluated in the ED with an electrocardiogram revealing a regular narrow complex tachycardia with a heart rate of 180 beats/min and a rhythm consistent with SVT. He reported experiencing 3Â days of fatigue, myalgias, palpitations, and dyspnea on exertion, but was otherwise hemodynamically stable. Attempts at chemical cardioversion with standard doses of adenosine (6Â mg, 12Â mg, and 12Â mg) were given without success. After consultation with the cardiology service, additional doses of 24Â mg and then 36Â mg of adenosine were administered. The last dose of 36Â mg produced sustained conversion and return to a normal sinus rhythm. The patient later underwent radiofrequency ablation of a left-sided orthodromic reciprocating accessory pathway. After 3Â months of medical management, the patient had an implantable cardiac defibrillator placed for prevention of sudden cardiac death.Why Should an Emergency Physician Be Aware of This?Each case of SVT demands immediate attention from an emergency physician. It is imperative that providers be aware of the limitations of adenosine and when it may be appropriate to deviate from standard dosing recommendations. This is in addition to collaborating with an expert in cardiac electrophysiology when initial management tactics are not successful.
Journal: The Journal of Emergency Medicine - Volume 50, Issue 3, March 2016, Pages 477-481