Paroxysmal supraventricular tachycardia - Revision history

Danbot: Add MedicationDose SMW annotations (6 entries: adenosine adult/peds, diltiazem, verapamil, metoprolol, esmolol); dosing verified per AHA ACLS guidelines

2026-03-20T16:36:15Z

Add MedicationDose SMW annotations (6 entries: adenosine adult/peds, diltiazem, verapamil, metoprolol, esmolol); dosing verified per AHA ACLS guidelines

@@ Line 153: / Line 153: @@
 **Recurrence more likely to occur in older patients and those with CVD
 ==See Also==
 *[[V Tach vs. SVT]]

Rossdonaldson1: /* Evaluation */

2025-07-30T17:05:34Z

Evaluation

← Older revision		Revision as of 17:05, 30 July 2025
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	==Evaluation==		==Evaluation==
	[[File:SVT12.jpg\|thumb\|PSVT at ~180 bpm]]		[[File:SVT12.jpg\|thumb\|PSVT at ~180 bpm]]

	{\| class="wikitable"		{\| class="wikitable"
	\| '''Symptoms'''		\| '''Symptoms'''

Rossdonaldson1: /* Adenosine */

2023-08-02T15:30:49Z

Adenosine

← Older revision		Revision as of 15:30, 2 August 2023
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	**Raise left arm above head immediately after push to facilitate rapid delivery to myocardium		**Raise left arm above head immediately after push to facilitate rapid delivery to myocardium
	*If unsuccessful, push 12mg (2nd dose)<ref>2015 ACLS</ref>		*If unsuccessful, push 12mg (2nd dose)<ref>2015 ACLS</ref>
	*If ~~2nd dose~~ unsuccessful, ~~can~~ consider repeat bolus of 12mg (3rd dose) (to a max of 30mg)		*If unsuccessful, consider repeat bolus of 12mg (3rd dose) (to a max of 30mg)
	**Some literature to support 3rd dose of 18mg<ref>Weismuller P et al. Terminating supraventricular tachycardia with adenosine--comparing the effectiveness of 12mg and 18mg. Dtsch Med Wochenschr. 2000 Aug 18;125(33):961-9.</ref>		**Some literature to support 3rd dose of 18mg<ref>Weismuller P et al. Terminating supraventricular tachycardia with adenosine--comparing the effectiveness of 12mg and 18mg. Dtsch Med Wochenschr. 2000 Aug 18;125(33):961-9.</ref>
	*If still unsuccessful, consider [[calcium channel blocker]] as below		*If still unsuccessful, consider [[calcium channel blocker]] as below

Rossdonaldson1: /* Other general comments */

2023-08-02T15:29:47Z

Other general comments

← Older revision		Revision as of 15:29, 2 August 2023
Line 102:		Line 102:
	*If unsuccessful, attempt second 0.1 mg/kg dose or escalate immediately to 0.2mg/kg (2nd dose) IV push		*If unsuccessful, attempt second 0.1 mg/kg dose or escalate immediately to 0.2mg/kg (2nd dose) IV push

	====Other ~~general comments~~====		====Other Considerations====
	*Relatively contraindicated in asthmatics due to increased bronchoconstriction		*Relatively contraindicated in asthmatics due to increased bronchoconstriction
	*Patients taking methylxanthines (eg [[caffeine]], [[theophylline]]) may require higher dose		*Patients taking methylxanthines (eg [[caffeine]], [[theophylline]]) may require higher dose

Rossdonaldson1: /* Adenosine */

2023-08-02T15:29:21Z

Adenosine

← Older revision		Revision as of 15:29, 2 August 2023
Line 94:		Line 94:
	*If unsuccessful, push 12mg (2nd dose)<ref>2015 ACLS</ref>		*If unsuccessful, push 12mg (2nd dose)<ref>2015 ACLS</ref>
	*If 2nd dose unsuccessful, can consider repeat bolus of 12mg (3rd dose) (to a max of 30mg)		*If 2nd dose unsuccessful, can consider repeat bolus of 12mg (3rd dose) (to a max of 30mg)
			**Some literature to support 3rd dose of 18mg<ref>Weismuller P et al. Terminating supraventricular tachycardia with adenosine--comparing the effectiveness of 12mg and 18mg. Dtsch Med Wochenschr. 2000 Aug 18;125(33):961-9.</ref>
	*If still unsuccessful, consider [[calcium channel blocker]] as below		*If still unsuccessful, consider [[calcium channel blocker]] as below
	**May have higher conversion rates and patient comfort in appropriate patients		**May have higher conversion rates and patient comfort in appropriate patients
Line 103:		Line 104:
	====Other general comments====		====Other general comments====
	*Relatively contraindicated in asthmatics due to increased bronchoconstriction		*Relatively contraindicated in asthmatics due to increased bronchoconstriction
	*Some literature to support 3rd dose of 18mg if 12mg fails<ref>Weismuller P et al. Terminating supraventricular tachycardia with adenosine--comparing the effectiveness of 12mg and 18mg. Dtsch Med Wochenschr. 2000 Aug 18;125(33):961-9.</ref>
	*Patients taking methylxanthines (eg [[caffeine]], [[theophylline]]) may require higher dose		*Patients taking methylxanthines (eg [[caffeine]], [[theophylline]]) may require higher dose
	*Consider initial adult dose of 3mg, if:<ref>ACLS Algorithms. https://acls-algorithms.com/acls-drugs/acls-and-adenosine/.</ref>		*Consider initial adult dose of 3mg, if:<ref>ACLS Algorithms. https://acls-algorithms.com/acls-drugs/acls-and-adenosine/.</ref>

Rossdonaldson1: /* Stable Management */

2023-08-02T15:28:15Z

Stable Management

← Older revision		Revision as of 15:28, 2 August 2023
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	===[[Adenosine]]===		===[[Adenosine]]===
	*'''Adults~~:'''~~		====Adults====
	**6mg rapid IV push (1st dose)		*6mg rapid IV push (1st dose)
	***Warn patient of sense of discomfort during transient sinus pause immediately following dose		**Warn patient of sense of discomfort during transient sinus pause immediately following dose
	***Ensure rapid push is through a large bore IV with proximity to the heart (left side antecubital preferred) as half-life of adenosine is less than 10 seconds <ref>https://www.rxlist.com/adenocard-drug.htm</ref>		**Ensure rapid push is through a large bore IV with proximity to the heart (left side antecubital preferred) as half-life of adenosine is less than 10 seconds <ref>https://www.rxlist.com/adenocard-drug.htm</ref>
	***Follow rapid push with 20cc rapid saline flush, consider use of Y-tubing or 3-way stopcock		**Follow rapid push with 20cc rapid saline flush, consider use of Y-tubing or 3-way stopcock
	***Raise left arm above head immediately after push to facilitate rapid delivery to myocardium		**Raise left arm above head immediately after push to facilitate rapid delivery to myocardium
	**If unsuccessful, push 12mg (2nd dose)<ref>2015 ACLS</ref>		*If unsuccessful, push 12mg (2nd dose)<ref>2015 ACLS</ref>
	**If 2nd dose unsuccessful, can consider repeat bolus of 12mg (3rd dose) (to a max of 30mg)		*If 2nd dose unsuccessful, can consider repeat bolus of 12mg (3rd dose) (to a max of 30mg)
	**If still unsuccessful, consider [[calcium channel blocker]] as below		*If still unsuccessful, consider [[calcium channel blocker]] as below
	***May have higher conversion rates and patient comfort in appropriate patients		**May have higher conversion rates and patient comfort in appropriate patients
	*'''Pediatrics~~:'''~~
	**0.1mg/kg (1st dose) rapid IV push as above		====Pediatrics====
	**If unsuccessful, attempt second 0.1 mg/kg dose or escalate immediately to 0.2mg/kg (2nd dose) IV push		*0.1mg/kg (1st dose) rapid IV push as above
	*'''Other general comments~~'''~~		*If unsuccessful, attempt second 0.1 mg/kg dose or escalate immediately to 0.2mg/kg (2nd dose) IV push
	**Relatively contraindicated in asthmatics due to increased bronchoconstriction
	**Some literature to support 3rd dose of 18mg if 12mg fails<ref>Weismuller P et al. Terminating supraventricular tachycardia with adenosine--comparing the effectiveness of 12mg and 18mg. Dtsch Med Wochenschr. 2000 Aug 18;125(33):961-9.</ref>		====Other general comments====
	**Patients taking methylxanthines (eg [[caffeine]], [[theophylline]]) may require higher dose		*Relatively contraindicated in asthmatics due to increased bronchoconstriction
	**Consider initial adult dose of 3mg, if:<ref>ACLS Algorithms. https://acls-algorithms.com/acls-drugs/acls-and-adenosine/.</ref>		*Some literature to support 3rd dose of 18mg if 12mg fails<ref>Weismuller P et al. Terminating supraventricular tachycardia with adenosine--comparing the effectiveness of 12mg and 18mg. Dtsch Med Wochenschr. 2000 Aug 18;125(33):961-9.</ref>
	***Central line		*Patients taking methylxanthines (eg [[caffeine]], [[theophylline]]) may require higher dose
	****Decreased transit time to heart		*Consider initial adult dose of 3mg, if:<ref>ACLS Algorithms. https://acls-algorithms.com/acls-drugs/acls-and-adenosine/.</ref>
	***Heart transplant		**Central line
	****Relative sensitivity of denervated transplanted hearts		***Decreased transit time to heart
	*****Note that full dose may be used safely, but initial half-dose is reasonable <ref>Flyer, J. et al. (2017) Prospective study of adenosine on atrioventricular nodal conduction in pediatric and young adult patients after heart transplant. Circulation, April 27</ref>		**Heart transplant
	***Taking carbamazepine or [[dipyridamole]]		***Relative sensitivity of denervated transplanted hearts
			****Note that full dose may be used safely, but initial half-dose is reasonable <ref>Flyer, J. et al. (2017) Prospective study of adenosine on atrioventricular nodal conduction in pediatric and young adult patients after heart transplant. Circulation, April 27</ref>
			**Taking carbamazepine or [[dipyridamole]]

	===[[Calcium-channel blockers]]===		===[[Calcium-channel blockers]]===

Rossdonaldson1: /* Adenosine */

2023-08-02T15:21:06Z

Adenosine

← Older revision		Revision as of 15:21, 2 August 2023
Line 99:		Line 99:
	**0.1mg/kg (1st dose) rapid IV push as above		**0.1mg/kg (1st dose) rapid IV push as above
	**If unsuccessful, attempt second 0.1 mg/kg dose or escalate immediately to 0.2mg/kg (2nd dose) IV push		**If unsuccessful, attempt second 0.1 mg/kg dose or escalate immediately to 0.2mg/kg (2nd dose) IV push
	*Relatively contraindicated in asthmatics due to increased bronchoconstriction		*'''Other general comments'''
	*Some literature to support 3rd dose of 18mg if 12mg fails<ref>Weismuller P et al. Terminating supraventricular tachycardia with adenosine--comparing the effectiveness of 12mg and 18mg. Dtsch Med Wochenschr. 2000 Aug 18;125(33):961-9.</ref>		**Relatively contraindicated in asthmatics due to increased bronchoconstriction
	*Patients taking methylxanthines (eg [[caffeine]], [[theophylline]]) may require higher dose		**Some literature to support 3rd dose of 18mg if 12mg fails<ref>Weismuller P et al. Terminating supraventricular tachycardia with adenosine--comparing the effectiveness of 12mg and 18mg. Dtsch Med Wochenschr. 2000 Aug 18;125(33):961-9.</ref>
	*Consider initial adult dose of 3mg, if:<ref>ACLS Algorithms. https://acls-algorithms.com/acls-drugs/acls-and-adenosine/.</ref>		**Patients taking methylxanthines (eg [[caffeine]], [[theophylline]]) may require higher dose
	**Central line		**Consider initial adult dose of 3mg, if:<ref>ACLS Algorithms. https://acls-algorithms.com/acls-drugs/acls-and-adenosine/.</ref>
	***Decreased transit time to heart		***Central line
	**Heart transplant		****Decreased transit time to heart
	***Relative sensitivity of denervated transplanted hearts		***Heart transplant
	****Note that full dose may be used safely, but initial half-dose is reasonable <ref>Flyer, J. et al. (2017) Prospective study of adenosine on atrioventricular nodal conduction in pediatric and young adult patients after heart transplant. Circulation, April 27</ref>		****Relative sensitivity of denervated transplanted hearts
	**Taking carbamazepine or [[dipyridamole]]		*****Note that full dose may be used safely, but initial half-dose is reasonable <ref>Flyer, J. et al. (2017) Prospective study of adenosine on atrioventricular nodal conduction in pediatric and young adult patients after heart transplant. Circulation, April 27</ref>
			***Taking carbamazepine or [[dipyridamole]]

	===[[Calcium-channel blockers]]===		===[[Calcium-channel blockers]]===

Rossdonaldson1: /* Adenosine */

2023-08-02T15:19:43Z

Adenosine

← Older revision		Revision as of 15:19, 2 August 2023
Line 90:		Line 90:
	***Warn patient of sense of discomfort during transient sinus pause immediately following dose		***Warn patient of sense of discomfort during transient sinus pause immediately following dose
	***Ensure rapid push is through a large bore IV with proximity to the heart (left side antecubital preferred) as half-life of adenosine is less than 10 seconds <ref>https://www.rxlist.com/adenocard-drug.htm</ref>		***Ensure rapid push is through a large bore IV with proximity to the heart (left side antecubital preferred) as half-life of adenosine is less than 10 seconds <ref>https://www.rxlist.com/adenocard-drug.htm</ref>
	***Follow rapid push with 20cc rapid saline flush, consider Y-tubing		***Follow rapid push with 20cc rapid saline flush, consider use of Y-tubing or 3-way stopcock
	***Raise left arm above head immediately after push to facilitate rapid delivery to myocardium		***Raise left arm above head immediately after push to facilitate rapid delivery to myocardium
	**If unsuccessful, push 12mg (2nd dose)<ref>2015 ACLS</ref>		**If unsuccessful, push 12mg (2nd dose)<ref>2015 ACLS</ref>

Rossdonaldson1: /* Adenosine */

2023-08-02T15:14:55Z

Adenosine

← Older revision		Revision as of 15:14, 2 August 2023
Line 88:		Line 88:
	*'''Adults:'''		*'''Adults:'''
	**6mg rapid IV push (1st dose)		**6mg rapid IV push (1st dose)
			***Warn patient of sense of discomfort during transient sinus pause immediately following dose
	***Ensure rapid push is through a large bore IV with proximity to the heart (left side antecubital preferred) as half-life of adenosine is less than 10 seconds <ref>https://www.rxlist.com/adenocard-drug.htm</ref>		***Ensure rapid push is through a large bore IV with proximity to the heart (left side antecubital preferred) as half-life of adenosine is less than 10 seconds <ref>https://www.rxlist.com/adenocard-drug.htm</ref>
	***Follow rapid push with 20cc rapid saline flush, consider Y-tubing.		***Follow rapid push with 20cc rapid saline flush, consider Y-tubing
	***Raise left arm above head immediately after push to facilitate rapid delivery to myocardium		***Raise left arm above head immediately after push to facilitate rapid delivery to myocardium
	**If unsuccessful, push 12mg (2nd dose)<ref>2015 ACLS</ref>		**If unsuccessful, push 12mg (2nd dose)<ref>2015 ACLS</ref>
	**If 2nd dose unsuccessful, can consider repeat bolus of 12mg (3rd dose) (to a max of 30mg)		**If 2nd dose unsuccessful, can consider repeat bolus of 12mg (3rd dose) (to a max of 30mg)
	***Warn patient of sense of discomfort during transient sinus pause immediately following dose
	**If still unsuccessful, consider [[calcium channel blocker]] as below		**If still unsuccessful, consider [[calcium channel blocker]] as below
	***May have higher conversion rates and patient comfort in appropriate patients		***May have higher conversion rates and patient comfort in appropriate patients

Chrismathew92: /* Adenosine */

2023-07-08T04:43:45Z

Adenosine

← Older revision		Revision as of 04:43, 8 July 2023
Line 91:		Line 91:
	***Follow rapid push with 20cc rapid saline flush, consider Y-tubing.		***Follow rapid push with 20cc rapid saline flush, consider Y-tubing.
	***Raise left arm above head immediately after push to facilitate rapid delivery to myocardium		***Raise left arm above head immediately after push to facilitate rapid delivery to myocardium
	**If unsuccessful, push ~~12 mg~~ (2nd dose)<ref>2015 ACLS</ref>		**If unsuccessful, push 12mg (2nd dose)<ref>2015 ACLS</ref>
	**If 2nd dose unsuccessful, consider [[calcium channel blocker]] as below		**If 2nd dose unsuccessful, can consider repeat bolus of 12mg (3rd dose) (to a max of 30mg)
			***Warn patient of sense of discomfort during transient sinus pause immediately following dose
			**If still unsuccessful, consider [[calcium channel blocker]] as below
	***May have higher conversion rates and patient comfort in appropriate patients		***May have higher conversion rates and patient comfort in appropriate patients
	*'''Pediatrics:'''		*'''Pediatrics:'''