Author: Paul Watson / Editor: Jason M Kendall / Reviewer: Nadarajah Prasanna, Phil Delbridge / Codes: CC3, CP3, HP2, ResP1, SLO1, SLO2, SLO6 / Published: 16/11/2023
A 48-year-old gentleman presents at 3am to the emergency department (ED) having woken at 2am with palpitations. He has known intermittent arrhythmias, with 6 episodes over the last 2 years. His last attendance was 1 month ago. He underwent electrophysiology at that time, and has been booked for ablation therapy in 3 days time. In preparation for this, his usual bisoprolol was stopped 4 days ago, as he must be free of any anti-arrhythmics for one week prior to the procedure.
On previous occasions attempts at cardioversion with adenosine have been unsuccessful; treatment with verapamil and electrical cardioversion have both been successful.
He has mild chest pain (3/10 severity), and is warm and sweaty. He had no dyspnoea or nausea.
He has no other previous medical history, and apart from his bisoprolol, has no other medications. He is a non-smoker.
His heart rate is 180 with a BP of 127/85.
He is keen to stress that he does not want any attempt at chemical cardioversion, as he does not want to jeopardise his forthcoming ablation therapy.
A nurse presents you with the following ECG:
Module Content
Supraventricular Tachycardias
Supraventricular Tachycardias can be divided into three pathophysiologicaly distinct conditions.
Tachycardias in the Resuscitation Room
This session covers management of tachycardias in the Resuscitation Room. It builds on the Resuscitation Council UK ALS Guidelines (2021) using selected evidence.
Broad Complex Tachycardias
This session covers the assessment and management of broad complex tachycardia.
14 Comments
very useful case
Good case
Clear, and useful.
very informative
Good case
My query is if patient had 6 unsuccessful attempt with adenosine in past, was it necessary to give another 3 doses with no effect this time.He needed electrical cardioversion anyway.
Good case
Good learning points
Thank you. Very helpful.
thanks
Good case
good
good recap
Great one