Supraventricular tachycardia differentiating SVT from VT: Difference between revisions

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{{Supraventricular tachycardia}}
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'''See also:''' [[Wide complex tachycardia]]
==Overview==
==Overview==
Most supraventricular tachycardias have a narrow [[QRS complex]] on the [[EKG]].  It is not infrequent, however, for aberrant conduction to be be present, sometimes as a result of the more rapid rate of conduction.  This widening of the QRS complex yields supraventricular tachycardia with aberrant conduction (SVTAC) which produces a [[wide-complex tachycardia]] that may mimic [[ventricular tachycardia]] (VT).  In the clinical setting, it is important to determine whether a [[wide-complex tachycardia]] is an [[SVT]] or a ventricular tachycardia, since they are treated differently.  Ventricular tachycardia has to be treated appropriately, since it can quickly degenerate to [[ventricular fibrillation]] and [[death]]. A number of different [[algorithm]]s have been devised to determine whether a wide complex tachycardia is supraventricular or ventricular in origin.<ref>{{cite journal |author=Lau EW, Ng GA |title=Comparison of the performance of three diagnostic algorithms for regular broad complex tachycardia in practical application |journal=Pacing and clinical electrophysiology : PACE |volume=25 |issue=5 |pages=822-7 |year=2002 |pmid=12049375 |doi=}}</ref>
In general, a history of structural heart disease, [[ischemic heart disease]] or [[congestive heart failure]] increases the likelihood that the tachycardia is ventricular in origin.


==Differentiating SVT from VT==
==Differentiating SVT from VT==
For a detailed discussion of how to distinguish [[ventricular tachycardia]] ([[VT]]) from [[supraventricular tachycardia]] ([[SVT]]), please visit the [[wide complex tachycardia differential diagnosis]] page.


Most supraventricular tachycardias have a narrow [[QRS complex]] on the [[EKG]].  It is not infrequent, however, for aberrant conduction to be be present, sometimes as a result of the more rapid rate of conduction.  This widening of the QRS complex yields supraventricular tachycardia with aberrant conduction (SVTAC) which produces a [[wide-complex tachycardia]] that may mimic [[ventricular tachycardia]] (VT).  In the clinical setting, it is important to determine whether a [[wide-complex tachycardia]] is an [[SVT]] or a [[ventricular tachycardia]], since they are treated differently. [[Ventricular tachycardia]] has to be treated appropriately, since it can quickly degenerate to [[ventricular fibrillation]] and [[death]]. A number of different [[algorithm]]s have been devised to determine whether a wide complex tachycardia is supraventricular or ventricular in origin.<ref>{{cite journal |author=Lau EW, Ng GA |title=Comparison of the performance of three diagnostic algorithms for regular broad complex tachycardia in practical application |journal=Pacing and clinical electrophysiology : PACE |volume=25 |issue=5 |pages=822-7 |year=2002 |pmid=12049375 |doi=}}</ref>
In brief, the diagnosis of [[VT]] is more likely if:
 
*There is a history of [[myocardial infarction]], [[congestive heart failure]] or [[structural heart disease]]
In general, a history of structural heart disease, [[ischemic heart disease]] or [[congestive heart failure]] increases the likelihood that the tachycardia is ventricular in origin.
*[[VT]] is more common in the elderly
*The [[electrical axis]] is -90 to -180 degrees (a “northwest” or “superior” axis)
*The [[QRS]] is > 140 msec
*There is [[AV dissociation]]. [[P waves]] are normal in morphology, upright, but dissociated from the QRS complex (i.e. "march through" the [[QRS complex]])
*There are positive or negative [[QRS]] complexes in all the precordial leads
*The morphology of the [[QRS]] complexes resembles that of a previous [[premature ventricular contraction]] ([[PVC]]).
*Rate: More than 100 bpm and usually 150-200 bpm
*Rhythm: The rhythm is regular
*[[PR interval]]: Variable PR interval
*Response to Maneuvers: VT does not terminate in response to [[adenosine]] or [[vagal maneuvers]]


==References==
==References==
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Latest revision as of 15:31, 20 August 2013

Supraventricular tachycardia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Among the Different Types of Supraventricular Tachycardia

Differentiating Supraventricular Tachycardia from Ventricular Tachycardia

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

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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]

See also: Wide complex tachycardia

Overview

Most supraventricular tachycardias have a narrow QRS complex on the EKG. It is not infrequent, however, for aberrant conduction to be be present, sometimes as a result of the more rapid rate of conduction. This widening of the QRS complex yields supraventricular tachycardia with aberrant conduction (SVTAC) which produces a wide-complex tachycardia that may mimic ventricular tachycardia (VT). In the clinical setting, it is important to determine whether a wide-complex tachycardia is an SVT or a ventricular tachycardia, since they are treated differently. Ventricular tachycardia has to be treated appropriately, since it can quickly degenerate to ventricular fibrillation and death. A number of different algorithms have been devised to determine whether a wide complex tachycardia is supraventricular or ventricular in origin.[1]

In general, a history of structural heart disease, ischemic heart disease or congestive heart failure increases the likelihood that the tachycardia is ventricular in origin.

Differentiating SVT from VT

For a detailed discussion of how to distinguish ventricular tachycardia (VT) from supraventricular tachycardia (SVT), please visit the wide complex tachycardia differential diagnosis page.

In brief, the diagnosis of VT is more likely if:

References

  1. Lau EW, Ng GA (2002). "Comparison of the performance of three diagnostic algorithms for regular broad complex tachycardia in practical application". Pacing and clinical electrophysiology : PACE. 25 (5): 822–7. PMID 12049375.


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