Supraventricular Tachycardia (SVT) Management Mnemonic

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SVT Management Mnemonic

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. šŸ“ˆ

Welcome to the world of Supraventricular Tachycardia (SVT) — the Usain Bolt of arrhythmias. Thankfully, the ABCDE mnemonic gives you a structured (and sanity-preserving) approach to its treatment.

Let’s break it down like we break tachycardia in the CCU: swiftly, decisively, and with a splash of humor.

šŸ’” SVT Management Mnemonic

Letter Intervention Mechanism Clinical Pearls
A Adenosine AV nodal blocker — transient AV block → resets circuit 6mg IV push. If no effect, repeat with 12mg. Be ready to explain asystole 😳
B Beta-blockers Slow AV nodal conduction Metoprolol or esmolol — great if adenosine fails or contraindicated
C Calcium channel blockers Non-dihydropyridines (verapamil, diltiazem) — slow AV nodal conduction Use with caution in hypotensive or elderly patients 🫣
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 → slows AV nodal conduction Valsalva, carotid sinus massage — best first move in stable SVT šŸ’Ŗ

 

šŸ„ 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 — classic AVNRT.

While the junior MO prepared the adenosine (and Google), I gave it a go with a modified Valsalva — legs up, blow into a syringe, the whole circus. And… boom šŸ’„ — sinus rhythm. No drugs. Just physiology and positioning.

Later, Dr. Imran Baloch walked in, saw the ECG, and said, “You should frame this — textbook Valsalva response.”

Most SVTs are benign but dramatic — much like hospital politics. The real skill is in recognition and knowing your ABCDEs cold. ECG interpretation is key. So is patient reassurance.

ā€œIf the rhythm looks fast, regular, and narrow — don’t panic. Just ABCDE it.ā€

And always remember: don’t give adenosine in irregular tachycardia — unless you’re in the mood for unmasking a pre-excited AF and a page from the mortuary. āš°ļø

That’s all! Happy learning, folks! šŸ™‚

Author: Dr. Aurangzaib Qambrani
Qualifications: MBBS, PLAB, MRCP-UK
Hospital: Sheikh Khalifa Bin Zayed Hospital, Quetta

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