Supraventricular tachycardia differential diagnosis

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Differentiating Among the Different Types of Supraventricular Tachycardia

Differentiating Supraventricular Tachycardia from Ventricular Tachycardia

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Acute Treatment of SVT of Unknown Mechanism
Ongoing Management of SVT of Unknown Mechanism
Ongoing Management of IST
Acute Treatment of Suspected Focal Atrial Tachycardia
Acute Treatment of Multifocal Atria Tachycardia
Ongoing Management of Multifocal Atrial Tachycardia
Acute Treatment of AVNRT
Ongoing Management of AVNRT
Acute Treatment of Orthodromic AVRT
Ongoing Management of Orthodromic AVRT
Asymptomatic Patients With Pre-Excitation
Management of Symptomatic Patients With Manifest Accessory Pathways
Acute Treatment of Atrial Flutter
Ongoing Management of Atrial Flutter
Acute Treatment of Junctional Tachycardia
Ongoing Management of Junctional Tachycardia
Acute Treatment of SVT in ACHD Patients
Ongoing Management of SVT in ACHD Patients
Acute Treatment of SVT in Pregnant Patients
Acute Treatment and Ongoing Management of SVT in Older Population

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Differentiating Among the Different Types of Supraventricular Tachycardia

The individual subtypes of SVT can be distinguished from each other by certain physiological and electrical characteristics, many of which present in the patient's EKG. Supraventricular tachycardias must be differentiated from each other because the management strategies may vary:

Epidemiology Rate Rhythm P waves PR Interval QRS complex Response to maneuvers
Sinus Tachycardia Greater than 100 bpm Regular Upright, consistent, and normal in morphology 0.12–0.20 sec and shortens with high heart rate Less than 0.12 seconds, consistent, and normal in morphology May break with vagal maneuvers
Atrial Fibrillation More common in the elderly, following bypass surgery, in mitral valve disease, hyperthyroidism 110 to 180 bpm Irregularly irregular Absent, fibrillatory waves Absent Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction Does not break with adenosine or vagal maneuvers
Atrial Flutter More common in the elderly, after alcohol 75 (4:1 block), 100 (3:1 block) and 150 (2:1 block) bpm, but 150 is more common Regular Sawtooth pattern of P waves at 250 to 350 beats per minute Varies depending upon the magnitude of the block, but is short Less than 0.12 seconds, consistent, and normal in morphology Conduction may vary in response to drugs and maneuvers dropping the rate from 150 to 100 or to 75 bpm
AV Nodal Reentry Tachycardia (AVNRT) Accounts for 60%-70% of all SVTs. 80% to 90% of cases are due to antegrade conduction down a slow pathway and retrograde up a fast pathway. In adults the range is 140-250 bpm, but in children the rate can exceed 250 bpm Regular The P wave is usually superimposed on or buried within the QRS complex Cannot be calculated as the P wave is generally obscured by the QRS complex Less than 0.12 seconds, consistent, and normal in morphology May break with adenosine or vagal maneuvers
AV Reciprocating Tachycardia (AVRT) More common in males, whereas AVNRT is more common in females, occurs at a younger age. More rapid than AVNRT Regular A retrograde P wave is seen either at the end of the QRS complex or at the beginning of the ST segment Less than 0.12 seconds Less than 0.12 seconds, consistent, and normal in morphology May break with adenosine or vagal maneuvers
Inappropriate Sinus Tachycardia The disorder is uncommon. Most patients are in their late 20s to early 30s. More common in women. > 95 beats per minute. A nocturnal reduction in heart rate is present. There is an inappropriate heart rate response on exertion. Regular Normal morphology and precede the QRS complex Normal and < 0.20 seconds Less than 0.12 seconds, consistent, and normal in morphology Does not break with adenosine or vagal maneuvers
Junctional Tachycardia Common after heart surgery, digitalis toxicity, as an escape rhythm in AV block > 60 beats per minute Regular Usually inverted, may be burried in the QRS complex The P wave is usually buried in the QRS complex Less than 0.12 seconds, consistent, and normal in morphology Does not break with adenosine or vagal maneuvers
Multifocal Atrial Tachycardia (MAT) High incidence in the elderly and in those with COPD Atrial rate is > 100 beats per minute (bpm) Irregular P waves of varying morphology from at least three different foci Variable PR intervals, RR intervals, and PP intervals Less than 0.12 seconds, consistent, and normal in morphology Does not terminate with adenosine or vagal maneuvers
Sinus Node Reentry Tachycardia 100 to 150 bpm Regular Upright P waves precede each regular, narrow QRS complex Short PR interval Less than 0.12 seconds, consistent, and normal in morphology Does often terminate with vagal maneuvers unlike sinus tachycardia.
Wolff-Parkinson-White syndrome Estimated prevalence of WPW syndrome is 100 - 300 per 100,000 in the entire world. Atrial rate is nearly 300 bpm and ventricular rate is at 150 bpm. Regular P wave generally follows the QRS complex due to a bypass tract Less than 0.12 seconds Delta wave and evidence of ventricular pre-excitation if there is conduction to the ventricle via ante-grade conduction down an accessory pathway May break in response to procainamide, adenosine, vagal maneuvers

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