There are few things that can disrupt your otherwise uneventful night shift like a young patient from Washuk, Balochistan showing up with palpitations, a heart rate of 210, and an ECG that looks like a barcode. š
Welcome to the world of Supraventricular Tachycardia (SVT) ā the Usain Bolt of arrhythmias. Thankfully, the ABCDE mnemonic gives you a structured (and sanity-preserving) approach to its treatment.
Letās break it down like we break tachycardia in the CCU: swiftly, decisively, and with a splash of humor.
š” SVT Management Mnemonic
| Letter | Intervention | Mechanism | Clinical Pearls |
|---|---|---|---|
| A | Adenosine | AV nodal blocker ā transient AV block ā resets circuit | 6mg IV push. If no effect, repeat with 12mg. Be ready to explain asystole š³ |
| B | Beta-blockers | Slow AV nodal conduction | Metoprolol or esmolol ā great if adenosine fails or contraindicated |
| C | Calcium channel blockers | Non-dihydropyridines (verapamil, diltiazem) ā slow AV nodal conduction | Use with caution in hypotensive or elderly patients š«£ |
| D | Digoxin | Enhances vagal tone, slows AV node | Less favored now, but sometimes useful in rate control for chronic cases |
| E | Excitation (vagal maneuvers) | Vagal stimulation ā slows AV nodal conduction | Valsalva, carotid sinus massage ā best first move in stable SVT šŖ |
š„ Clinical Insights from the Quetta Frontline
Few weeks ago, a 29-year-old shopkeeper from Nushki came in mid-rickshaw ride with chest pounding like a tabla. ECG confirmed a narrow-complex regular tachycardia ā classic AVNRT.
While the junior MO prepared the adenosine (and Google), I gave it a go with a modified Valsalva ā legs up, blow into a syringe, the whole circus. Andā¦ boom š„ ā sinus rhythm. No drugs. Just physiology and positioning.
Later, Dr. Imran Baloch walked in, saw the ECG, and said, “You should frame this ā textbook Valsalva response.”
Most SVTs are benign but dramatic ā much like hospital politics. The real skill is in recognition and knowing your ABCDEs cold. ECG interpretation is key. So is patient reassurance.
āIf the rhythm looks fast, regular, and narrow ā donāt panic. Just ABCDE it.ā
And always remember: donāt give adenosine in irregular tachycardia ā unless you’re in the mood for unmasking a pre-excited AF and a page from the mortuary. ā°ļø
That’s all! Happy learning, folks! š
Author: Dr. Aurangzaib Qambrani
Qualifications: MBBS, PLAB, MRCP-UK
Hospital: Sheikh Khalifa Bin Zayed Hospital, Quetta
