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Paroxysmal Supraventricular Tachycardia (PSVT) is a type of abnormal heart rhythm characterized by a rapid heartbeat originating above the heart’s ventricles in the AV node due to re-entry phenomenon. The management of PSVT involves both acute treatment to terminate ongoing episodes and long-term strategies to prevent future occurrences.

Notice the narrow qRS complexes (Blue arrow) with Heart rate of 250 bpm. ST depression (red arrow) is due to sudden increase in oxygen demand of heart. Hidden P waves are noticed (black Star mark).

Interventions

1. Vagal Maneuvers
   – The first-line approach for terminating an acute episode of PSVT involves vagal maneuvers. These include techniques such as:
   • Valsalva maneuver (bearing down as if having a bowel movement)
   • Carotid sinus massage (Contraindicated in Carotid artery Stenosis due to the risk of stroke)
   • Don’t answer from this algorithm BP is crashing where Synchronized DC shock is the treatment of choice.
2. Adenosine
   – Administer intravenous adenosine, that slows down re-entry phenomenon in the heart and restore normal rhythm.
3. Calcium Channel Blockers or Beta-Blockers
   – Medications such as verapamil or diltiazem (calcium channel blockers) or metoprolol (beta-blocker) may be prescribed for long-term management to prevent recurrent episodes.
4. Antiarrhythmic Medications
   – In some cases, antiarrhythmic medications like flecainide or propafenone may be prescribed to help maintain a normal heart rhythm.
5. Catheter Ablation
   – For individuals with recurrent or poorly controlled PSVT, catheter ablation may be recommended. This procedure involves the use of radiofrequency energy to destroy the abnormal pathway causing the rapid heart rate.
6. Lifestyle Modifications:
   • – Avoiding triggers such as excessive caffeine or stimulant intake.
     
   • – Managing stress through relaxation techniques.
   • – Staying well-hydrated.
7. Regular Follow-Up:
   – Regular follow-up appointments with a cardiologist are essential to monitor the effectiveness of the chosen treatment plan and adjust as needed.
8. When to seek Emergency Medical Attention:
     – Inform patient that if PSVT is associated with severe symptoms, such as chest pain, shortness of breath, or loss of consciousness

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