Emergency department management of the pediatric patient with supraventricular tachycardia.
Supraventricular tachycardia (SVT) is the most common tachyarrhythmia that necessitates treatment in children. It is characterized by a rapid and regular heart rate, which generally exceeds 180 beats per minute in children and 220 beats per minute in adolescents. Supraventricular tachycardia results from conduction of electrical impulses along an accessory connection from the atrium to the ventricle (atrioventricular reentry tachycardias: orthodromic or antidromic) or conduction within the atrioventricular node (atrioventricular node reentry tachycardia). Emergency department management of SVT depends on the patient's clinical status. Treatment of a stable patient with SVT includes vagal maneuvers and adenosine, whereas treatment of an unstable patient requires synchronized cardioversion. This article presents an overview of the etiology, pathophysiology, and clinical presentation of SVT and discusses the emergency department management of an infant or child with SVT.
Manole
Mioara D
MD
Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA. mioara.manole@chp.edu.
Saladino
Richard A
RA
D000241:Adenosine / Q000627:therapeutic use; D000465:Algorithms; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001283:Atrioventricular Node / Q000503:physiopathology; D002346:Carotid Sinus; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D019468:Disease Management; D004554:Electric Countershock; D004562:Electrocardiography; D004630:Emergencies; D004636:Emergency Service, Hospital; D006339:Heart Rate; D006801:Humans; D007223:Infant; D008405:Massage; D012018:Reflex; D013616:Tachycardia, Sinus / Q000175:diagnosis; D013617:Tachycardia, Supraventricular / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014630:Vagus Nerve / Q000503:physiopathology; D014636:Valsalva Maneuver
D000889:Anti-Arrhythmia Agents; D000241:Adenosine