Paroxysmal Supraventricular Tachycardia (PSVT)

Introduction

Paroxysmal Supraventricular Tachycardia (PSVT) is a condition where the heart suddenly beats much faster than normal due to abnormal electrical activity above the ventricles. It's usually not life-threatening, but it can cause uncomfortable symptoms and may require treatment.

Causes

PSVT occurs due to abnormal circuits in the heart's electrical system, often in the atria or atrioventricular (AV) node. The most common mechanisms include: - Atrioventricular Reentrant Tachycardia (AVRT) – abnormal electrical connection between atria and ventricles. - Atrioventricular Nodal Reentrant Tachycardia (AVNRT) – reentry circuit within the AV node. - Automatic Atrial Tachycardia – abnormal impulse generation in the atria.

Symptoms

Common symptoms of PSVT include: - Rapid heartbeat (palpitations) - Dizziness or lightheadedness - Shortness of breath - Chest discomfort (not the same as angina) - Anxiety or a feeling of unease

Diagnosis

PSVT is diagnosed using: - Electrocardiogram (ECG) to capture an episode - Holter monitoring for longer recordings - Electrophysiological study (EPS) for detailed mapping of cardiac conduction

Treatments

Acute Management

  • Vagal maneuvers (e.g., Valsalva maneuver, carotid sinus massage)
  • Adenosine injection to interrupt abnormal conduction
  • Beta-blockers or calcium channel blockers
  • Cardioversion (in severe cases)

Long-term Management

  • Medications (beta-blockers, calcium channel blockers, antiarrhythmics)
  • Catheter ablation (a procedure to destroy abnormal circuits, often curative)
  • Lifestyle adjustments (avoiding triggers like caffeine, alcohol, stress)

Summary

PSVT is a manageable condition with good prognosis. Proper diagnosis and appropriate treatment, from simple vagal maneuvers to catheter ablation, can help patients lead a normal life without recurrent episodes.

Source recommendations

1. American Heart Association Guidelines on Supraventricular Arrhythmias

  1. https://www.ahajournals.org/doi/10.1161/cir.0000000000000311
  2. https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/tachycardia--fast-heart-rate
  3. https://pubmed.ncbi.nlm.nih.gov/14557344/
  4. https://professional.heart.org/en/science-news/-/media/028ddd505f514ea2b3a4e74bb72e3557.ashx
  5. https://pubmed.ncbi.nlm.nih.gov/14563598/

2. European Society of Cardiology Guidelines for the Management of Supraventricular Tachycardias

  1. https://academic.oup.com/eurheartj/article/41/5/655/5556821
  2. https://pubmed.ncbi.nlm.nih.gov/31504425/
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Supraventricular-Tachycardia
  4. https://pubmed.ncbi.nlm.nih.gov/14557344/
  5. https://www.ahajournals.org/doi/10.1161/cir.0000000000000311

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