CASE DISCUSSION 3

SUPRAVENTRICULAR TACHYCARDIA

INTRODUCTION [1,2]

 Supraventricular tachycardia (SVT) is as an abnormally fast or erratic heartbeat that

affects the heart's upper chambers. 

 SVT is also called paroxysmal supraventricular tachycardia.

 SVT is the most common rhythm disturbance in children.

TYPES OF SVT [1,2]

 Atrioventricular re-entry tachyarrhythmia (AVRT)

 Atrioventricular nodal re-entry tachyarrhythmia (AVNRT)
 Atrial tachyarrhythmia (AT)

EPIDEMIOLOGY [3]

 The true incidence of SVT in children is unknown but has been estimated to be 1 in
250 to 1 in 1000 children. 

 Approximately 50% of children with SVT will present with their first episode in the
first year of life. 

 Incidence of SVT has been estimated at 1 in every 250–1000 pediatric patients in

India.

ETIOLOGY [4]

 SVT are caused by faulty electrical connections in the heart with unknown reason
 This may be induced by premature atrial or ventricular ectopic beats
 Infection
 Exercise
 Medications (Bronchodilators and Digoxin)

Pathophysiology [5]

SVT occurs via two mechanisms:

 Re-entry: Re-entrant tachycardia, also called reciprocating tachycardia is a
continuous repetitive propagation of the activation wave in a circular path, returning
to its site of origin to reactivate that site.
 Automaticity: or spontaneous impulse initiation, is the ability of cardiac cells to
depolarize spontaneously, and initiate a propagated action potential (AP) in the
absence of external electrical stimulation
RISK FACTORS [4]

 Congenital heart disease

 Low birth weight

 Cardiac surgery

COMPLICATION [7]

 Development of Acute Congestive Heart Failure

 Myocardial Dysfunction
 Chronic Tachycardia
 Tachycardia-induced cardiomyopathy
 Neurologic morbidity
 Necrotizing enterocolitis
 Death

DIAGNOSIS [8]

 History
 Physical Examination
 Electrocardiogram (narrow complex, regular tachycardia with a rate of approximately
180 to 220 beats per minute. P waves are not detectable)
 Holter Monitor

MANAGEMENT [9,10,11]

 Acute Management of SVT

 Vagal maneuvers: If hemodynamically stable - vagal maneuvers before
pharmacologic therapy.
 Intravenous Adenosine: Drug of choice for acute termination of SVT. Dose: 0.1-0.2
mg/kg, given as a rapid IV bolus
 When patient does not respond to Adenosine, synchronized cardioversion is
indicated with 0.5-1 Joules/Kg. If not effective 2joules/kg is given
 Intravenous Verapamil: For terminating re-entrant SVT. Verapamil should not be
used in children< 4 years old and in the presence of heart failure or pre-excitation on
the ECG. Dose: 0.4-0.8mg/kg/day in divided doses. A single bolus of Verapamil may
be followed by additional one or two mg boluses 10 min apart if initial dose does not
terminate the SVT.
 CASE STUDY

SUBJECTIVE

Name: Ms. AB
Age: 5yrs
Gender: Female
Chief complaints: C/O fever and cough of 2 days
Past Medical History: Nil
Past Medical History: Nil
Family History: NIL
Social History: NIL
Allergies (Food & Drug): NIL

OBJECTIVE

Chest examination showed evidence of pneumonia in the right lower lobe. ECG
revealed narrow complex tachycardia
Weight: 10kg
HR: 214bpm
RR: 44breaths/min
ECG showed a run of SVT

ASSESSMENT

SUPRAVENTRICULAR TACHYCARDIA/PNEUMONIA

PLAN

Valsalva manoeuvre and application of ice packs to the face failed to change the heart rate,
DAY DRUGS DOSE FREQUENCY

1 Diazepam (rectally)- Rhythm was not 2.5mg OD

reverted

Inj. Adenosine 0.5mg- (Rhythm was not OD

reverted)
1mg- (Reverted the rhythm
to normal and HR:
138bpm)

INTERVENTIONS [9,10]

 Patient should have been prescribed with 1mg of adenosine according to his weight.
 Patient’s BP was not mentioned on the case report.
 Diazepam should not have been prescribed in this patient. Adenosine is the first line
choice of Drug.
 Pneumonia was not managed on this patient.

PHARMACEUTICAL CARE PLAN [10]

DRUG DOSE FREQUENCY

Inj. Adenosine 1mg OD

Tab Azithromycin 100mg OD-3days

DISCHARGE PLAN [9,11]

DRUG DOSE FREQUENCY

T.Propranolol 10mg TID

Syr. Digoxin 0.05mg BD(2.5ml)

Dose Calculation:

Adenosine:

Actual Dose: 0.1mg/kg/day

Calculated Dose: 10*0.1 mg/kg/day = 1mg/Day

Azithromycin

Actual Dose: 10mg/kg/day

Calculated dose: 10* 10mg/kg\day = 100mg/Day

PATIENT COUNSELLING [4,7,8]

Regarding Disease:

• Patient’s care giver was explained that SVT is abnormal increase in the heart rate of
more than 220bpm.

• Signs and Symptoms (rapid heart rate, heart palpitations, dizziness, light headedness,
chest discomfort, upset stomach, weakness, poor feeding, irritability, vomiting) were
informed to the care giver.

• Risk Factors (congenital heart disease, cardiac sugery) were explained.

• Patient’s care giver was explained that the problem is usually not life- threatening and
there are safe and effective treatments available.

Regarding Drugs:

• Patients care taker is asked to give the medications regularly

• T. Propranolol to be given thrice daily and the side effects include hypotension,
hypoglycaemia and change in sleep pattern

• Syrup Digoxin should be given twice daily and side effects include anorexia, nausea,
diarrhoea, lethargy, confusion, vertigo, blurred vision, diplopia and tinnitus.

• If a dose is missed, the patients care giver is asked to continue with the usual schedule
and not to double the dose

Regarding Lifestyle Modification

• Patient’s caregiver was counselled on vagal maneuver

• Patient’s care giver is asked to give healthy foods such as spinach, avocadoes, brown
rice.

• Patient’s care giver is asked to avoid giving spicy foods, or cold drinks

• Activity restrictions are not necessary for children with SVT and the child may
participate in all physical activities. If an episode occurs during competition, the child
should remove himself from participation until the arrhythmia is converted
MONITORING PARAMETERS AND BRAND NAMES

DRUGS BRAND NAME MONITORING PARAMETERS

Adenosine ADENOJECT ECG

Propranolol CIPLAR 10 Electrolytes, BP, Blood sugar

Digoxin CARDIOXIN HR, ECG, electrolytes, Serum

concentrations
REFERENCES

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Tachyarrhythmia in Pediatric Population: a Review Article. 30th January 2017.
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7. 7. Moak JP. Supraventricular tachycardia in the neonate and infant. Progress in

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9. Gowrishankar NC, Thangavelu S. INDIAN JOURNAL OF PRACTICAL

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10. 10. Judy Haluka. The Basics of the Pediatric Tachycardia for Pediatric Advanced Life
Support. 19th May 2019. Available from: https://www.dicardiology.com/article/basics-
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11. 11. Anitha Saxena. Drug Therapy of Cardiac Diseases in Children. Working Group
On Management of Congenital Heart Diseases in India. 17th April 2009. Available
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