Paroxysmal Supraventricular Tachycardia (PSVT) is abnormal heart rhythm or arrhythmia that originates above the heart’s ventricles, typically in the atria or atrioventricular (AV) node. It is characterized by sudden and rapid episodes of an abnormally fast heartbeat, known as tachycardia. During a PSVT episode, the heart can beat much faster than its normal rate, often exceeding 150 to 200 beats per minute.
PSVT can occur for various reasons, including congenital abnormalities in the heart’s electrical system, heart diseases, stress, caffeine or alcohol consumption, certain medications, and other triggers. In some cases, there may be no identifiable cause. PSVT is typically not life-threatening, but it can significantly affect a person’s quality of life if left untreated. With appropriate treatment and management, many individuals with PSVT can lead normal, healthy lives.
Epidemiology
Paroxysmal Supraventricular Tachycardia is a relatively common arrhythmia. It can affect individuals of all ages, from infants to the elderly. The prevalence increases with age and is more commonly observed in adults. The annual incidence of PSVT is estimated to be around 35 to 50 cases per 100,000 person-years. It can occur at any age but is more frequently observed in adults, particularly in individuals over 65.
However, it can also affect infants and children, often due to congenital heart conditions. The prevalence and incidence may vary from region to region. Access to healthcare, genetic factors, and environmental influences can all play a role in these variations. Certain lifestyle factors and triggers can increase the likelihood of PSVT episodes. These include stress, caffeine consumption, alcohol intake, smoking, and certain medications.
Anatomy
Pathophysiology
The most common cause of PSVT is the presence of an abnormal electrical pathway, often referred to as a “reentry circuit.” In this scenario, an extra or accessory pathway allows electrical impulses to travel in a loop, bypassing the normal conduction system’s regulatory mechanisms. This leads to a rapid, repetitive circuit of electrical impulses within the atria (atrial re-entrant tachycardia) or between the atria and ventricles (atrioventricular re-entrant tachycardia).
The abnormal circuit leads to a tachycardic rhythm. In some cases, PSVT can be triggered by the spontaneous firing of an ectopic focus, which is an area of the heart outside the SA node that starts generating electrical impulses at a rapid rate. This can occur in the atria or other regions. The rapid and disorganized electrical impulses in PSVT disrupt the heart’s normal rhythm and coordination. Instead of the usual synchronized contraction of the atria and ventricles, the heart contracts rapidly and inefficiently.
This can lead to reduced cardiac output, resulting in symptoms such as palpitations, dizziness, shortness of breath, and chest discomfort. In some cases, PSVT episodes can self-terminate as the abnormal electrical pathway becomes fatigued or as the body’s natural regulatory mechanisms kick in to restore a normal heart rate. However, in many cases, medical intervention is required to stop the episode and prevent its recurrence.
Etiology
The etiology of Paroxysmal Supraventricular Tachycardia (PSVT) refers to the underlying causes or factors that can lead to the development of this type of abnormal heart rhythm. PSVT is characterized by sudden and recurrent episodes of rapid heart rate, but its underlying causes can vary from person to person.
Accessory Pathways: One of the primary causes of PSVT is the presence of abnormal electrical pathways in the heart, often referred to as accessory pathways. These pathways allow electrical impulses to bypass the normal conduction system, leading to re-entrant tachycardias. Two common types of accessory pathways are the Kent bundle (associated with Wolff-Parkinson-White syndrome) and the Mahaim pathway.
Structural Heart Abnormalities: Certain structural abnormalities of the heart can predispose individuals to PSVT. These abnormalities may include congenital heart defects, enlarged atria, or scar tissue from previous heart surgery.
Caffeine and Stimulants: Excessive consumption of caffeine or other stimulants, such as certain medications or illicit drugs, can stimulate the heart and trigger PSVT episodes in susceptible individuals.
Alcohol: Some individuals may experience PSVT episodes after consuming alcohol. Alcohol can affect the heart’s electrical conduction system and increase the risk of arrhythmias.
Electrolyte Imbalances: Abnormal levels of electrolytes in the blood, such as potassium, sodium, and calcium, can disrupt the heart’s electrical activity and trigger PSVT.
Genetics
Prognostic Factors
Clinical History
PSVT can occur in individuals of any age, but certain risk factors may increase the likelihood of developing it. These risk factors include a family history of arrhythmias, heart disease, excessive caffeine or alcohol consumption, smoking, and stress. The hallmark sign of PSVT is a sudden and rapid heartbeat, often exceeding 100 to 150 beats per minute.
Due to the rapid heart rate, there may be inadequate blood flow to the brain. In severe cases, PSVT may lead to syncope or fainting episodes. Some individuals may experience chest pain or discomfort. The episodes of PSVT can vary in duration. They may last a few seconds to several hours and, in some cases, even longer. Most commonly, episodes resolve independently within a few minutes to hours, but some may require medical intervention to terminate.
Physical Examination
The hallmark of PSVT is an abnormally fast heart rate, typically exceeding 150 to 200 beats per minute during an episode. Healthcare providers will check the pulse to assess the heart rate. Patients may report a sensation of rapid, strong, or irregular heartbeats, which is often described as palpitations. These can be felt by the patient or sometimes observed by the healthcare provider during the examination.
Some individuals may experience elevated blood pressure, while others may have normal or lower-than-normal blood pressure. This variation can depend on factors like the duration and frequency of the tachycardic episodes. During PSVT episodes, some individuals may appear pale or have cool, clammy skin due to decreased blood flow to the extremities. Patients may report various symptoms, such as dizziness, light-headedness, shortness of breath, chest discomfort, or syncope.
The examination may include an assessment of the jugular venous pressure in the neck, which can be elevated during PSVT episodes, particularly in cases with decreased blood flow from the heart. During PSVT, abnormal heart sounds such as a rapid, regular, or irregular rhythm may be heard. The absence of normal variations in heart sounds, like the “lub-dub” pattern, is a characteristic finding.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Atrial flutter
Atrial fibrillation
Atrial tachycardia
Intra-atrial reentrant tachycardia
Inappropriate sinus tachycardia
Sinoatrial node reentrant tachycardia
Junctional ectopic tachycardia
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
If the 12-lead ECG indicates an irregular rhythm with the absence of discernible P waves, the patient should be managed for atrial fibrillation. The patient should be treated for atrial flutter when the ECG displays an irregular rhythm with identifiable flutter waves. When the ECG reveals an irregular rhythm with multiple P wave morphologies, the patient should be managed for multifocal atrial tachycardia.
For patients with hemodynamic stability and a regular rhythm on the ECG but undetectable P waves, various interventions may aid in diagnosis and management. These can include Valsalva maneuvers, carotid sinus massage, intravenous adenosine administration, or altering the ECG paper speed from 25 mm per second to 50 mm per second.
If intravenous adenosine proves ineffective, healthcare providers may resort to intravenous or oral calcium channel blockers or beta-blockers to manage the condition. Additionally, patients with PSVT should undergo an evaluation to assess for any underlying pre-excitation syndrome. Those who do not respond to medical treatment or may be candidates for radiofrequency catheter ablation should receive a cardiology consultation.
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Paroxysmal Supraventricular Tachycardia (PSVT) is abnormal heart rhythm or arrhythmia that originates above the heart’s ventricles, typically in the atria or atrioventricular (AV) node. It is characterized by sudden and rapid episodes of an abnormally fast heartbeat, known as tachycardia. During a PSVT episode, the heart can beat much faster than its normal rate, often exceeding 150 to 200 beats per minute.
PSVT can occur for various reasons, including congenital abnormalities in the heart’s electrical system, heart diseases, stress, caffeine or alcohol consumption, certain medications, and other triggers. In some cases, there may be no identifiable cause. PSVT is typically not life-threatening, but it can significantly affect a person’s quality of life if left untreated. With appropriate treatment and management, many individuals with PSVT can lead normal, healthy lives.
Paroxysmal Supraventricular Tachycardia is a relatively common arrhythmia. It can affect individuals of all ages, from infants to the elderly. The prevalence increases with age and is more commonly observed in adults. The annual incidence of PSVT is estimated to be around 35 to 50 cases per 100,000 person-years. It can occur at any age but is more frequently observed in adults, particularly in individuals over 65.
However, it can also affect infants and children, often due to congenital heart conditions. The prevalence and incidence may vary from region to region. Access to healthcare, genetic factors, and environmental influences can all play a role in these variations. Certain lifestyle factors and triggers can increase the likelihood of PSVT episodes. These include stress, caffeine consumption, alcohol intake, smoking, and certain medications.
The most common cause of PSVT is the presence of an abnormal electrical pathway, often referred to as a “reentry circuit.” In this scenario, an extra or accessory pathway allows electrical impulses to travel in a loop, bypassing the normal conduction system’s regulatory mechanisms. This leads to a rapid, repetitive circuit of electrical impulses within the atria (atrial re-entrant tachycardia) or between the atria and ventricles (atrioventricular re-entrant tachycardia).
The abnormal circuit leads to a tachycardic rhythm. In some cases, PSVT can be triggered by the spontaneous firing of an ectopic focus, which is an area of the heart outside the SA node that starts generating electrical impulses at a rapid rate. This can occur in the atria or other regions. The rapid and disorganized electrical impulses in PSVT disrupt the heart’s normal rhythm and coordination. Instead of the usual synchronized contraction of the atria and ventricles, the heart contracts rapidly and inefficiently.
This can lead to reduced cardiac output, resulting in symptoms such as palpitations, dizziness, shortness of breath, and chest discomfort. In some cases, PSVT episodes can self-terminate as the abnormal electrical pathway becomes fatigued or as the body’s natural regulatory mechanisms kick in to restore a normal heart rate. However, in many cases, medical intervention is required to stop the episode and prevent its recurrence.
The etiology of Paroxysmal Supraventricular Tachycardia (PSVT) refers to the underlying causes or factors that can lead to the development of this type of abnormal heart rhythm. PSVT is characterized by sudden and recurrent episodes of rapid heart rate, but its underlying causes can vary from person to person.
Accessory Pathways: One of the primary causes of PSVT is the presence of abnormal electrical pathways in the heart, often referred to as accessory pathways. These pathways allow electrical impulses to bypass the normal conduction system, leading to re-entrant tachycardias. Two common types of accessory pathways are the Kent bundle (associated with Wolff-Parkinson-White syndrome) and the Mahaim pathway.
Structural Heart Abnormalities: Certain structural abnormalities of the heart can predispose individuals to PSVT. These abnormalities may include congenital heart defects, enlarged atria, or scar tissue from previous heart surgery.
Caffeine and Stimulants: Excessive consumption of caffeine or other stimulants, such as certain medications or illicit drugs, can stimulate the heart and trigger PSVT episodes in susceptible individuals.
Alcohol: Some individuals may experience PSVT episodes after consuming alcohol. Alcohol can affect the heart’s electrical conduction system and increase the risk of arrhythmias.
Electrolyte Imbalances: Abnormal levels of electrolytes in the blood, such as potassium, sodium, and calcium, can disrupt the heart’s electrical activity and trigger PSVT.
PSVT can occur in individuals of any age, but certain risk factors may increase the likelihood of developing it. These risk factors include a family history of arrhythmias, heart disease, excessive caffeine or alcohol consumption, smoking, and stress. The hallmark sign of PSVT is a sudden and rapid heartbeat, often exceeding 100 to 150 beats per minute.
Due to the rapid heart rate, there may be inadequate blood flow to the brain. In severe cases, PSVT may lead to syncope or fainting episodes. Some individuals may experience chest pain or discomfort. The episodes of PSVT can vary in duration. They may last a few seconds to several hours and, in some cases, even longer. Most commonly, episodes resolve independently within a few minutes to hours, but some may require medical intervention to terminate.
The hallmark of PSVT is an abnormally fast heart rate, typically exceeding 150 to 200 beats per minute during an episode. Healthcare providers will check the pulse to assess the heart rate. Patients may report a sensation of rapid, strong, or irregular heartbeats, which is often described as palpitations. These can be felt by the patient or sometimes observed by the healthcare provider during the examination.
Some individuals may experience elevated blood pressure, while others may have normal or lower-than-normal blood pressure. This variation can depend on factors like the duration and frequency of the tachycardic episodes. During PSVT episodes, some individuals may appear pale or have cool, clammy skin due to decreased blood flow to the extremities. Patients may report various symptoms, such as dizziness, light-headedness, shortness of breath, chest discomfort, or syncope.
The examination may include an assessment of the jugular venous pressure in the neck, which can be elevated during PSVT episodes, particularly in cases with decreased blood flow from the heart. During PSVT, abnormal heart sounds such as a rapid, regular, or irregular rhythm may be heard. The absence of normal variations in heart sounds, like the “lub-dub” pattern, is a characteristic finding.
Atrial flutter
Atrial fibrillation
Atrial tachycardia
Intra-atrial reentrant tachycardia
Inappropriate sinus tachycardia
Sinoatrial node reentrant tachycardia
Junctional ectopic tachycardia
If the 12-lead ECG indicates an irregular rhythm with the absence of discernible P waves, the patient should be managed for atrial fibrillation. The patient should be treated for atrial flutter when the ECG displays an irregular rhythm with identifiable flutter waves. When the ECG reveals an irregular rhythm with multiple P wave morphologies, the patient should be managed for multifocal atrial tachycardia.
For patients with hemodynamic stability and a regular rhythm on the ECG but undetectable P waves, various interventions may aid in diagnosis and management. These can include Valsalva maneuvers, carotid sinus massage, intravenous adenosine administration, or altering the ECG paper speed from 25 mm per second to 50 mm per second.
If intravenous adenosine proves ineffective, healthcare providers may resort to intravenous or oral calcium channel blockers or beta-blockers to manage the condition. Additionally, patients with PSVT should undergo an evaluation to assess for any underlying pre-excitation syndrome. Those who do not respond to medical treatment or may be candidates for radiofrequency catheter ablation should receive a cardiology consultation.
medtigo
Paroxysmal supraventricular tachycardia
Updated :
September 23, 2023
Paroxysmal Supraventricular Tachycardia (PSVT) is abnormal heart rhythm or arrhythmia that originates above the heart’s ventricles, typically in the atria or atrioventricular (AV) node. It is characterized by sudden and rapid episodes of an abnormally fast heartbeat, known as tachycardia. During a PSVT episode, the heart can beat much faster than its normal rate, often exceeding 150 to 200 beats per minute.
PSVT can occur for various reasons, including congenital abnormalities in the heart’s electrical system, heart diseases, stress, caffeine or alcohol consumption, certain medications, and other triggers. In some cases, there may be no identifiable cause. PSVT is typically not life-threatening, but it can significantly affect a person’s quality of life if left untreated. With appropriate treatment and management, many individuals with PSVT can lead normal, healthy lives.
Paroxysmal Supraventricular Tachycardia is a relatively common arrhythmia. It can affect individuals of all ages, from infants to the elderly. The prevalence increases with age and is more commonly observed in adults. The annual incidence of PSVT is estimated to be around 35 to 50 cases per 100,000 person-years. It can occur at any age but is more frequently observed in adults, particularly in individuals over 65.
However, it can also affect infants and children, often due to congenital heart conditions. The prevalence and incidence may vary from region to region. Access to healthcare, genetic factors, and environmental influences can all play a role in these variations. Certain lifestyle factors and triggers can increase the likelihood of PSVT episodes. These include stress, caffeine consumption, alcohol intake, smoking, and certain medications.
The most common cause of PSVT is the presence of an abnormal electrical pathway, often referred to as a “reentry circuit.” In this scenario, an extra or accessory pathway allows electrical impulses to travel in a loop, bypassing the normal conduction system’s regulatory mechanisms. This leads to a rapid, repetitive circuit of electrical impulses within the atria (atrial re-entrant tachycardia) or between the atria and ventricles (atrioventricular re-entrant tachycardia).
The abnormal circuit leads to a tachycardic rhythm. In some cases, PSVT can be triggered by the spontaneous firing of an ectopic focus, which is an area of the heart outside the SA node that starts generating electrical impulses at a rapid rate. This can occur in the atria or other regions. The rapid and disorganized electrical impulses in PSVT disrupt the heart’s normal rhythm and coordination. Instead of the usual synchronized contraction of the atria and ventricles, the heart contracts rapidly and inefficiently.
This can lead to reduced cardiac output, resulting in symptoms such as palpitations, dizziness, shortness of breath, and chest discomfort. In some cases, PSVT episodes can self-terminate as the abnormal electrical pathway becomes fatigued or as the body’s natural regulatory mechanisms kick in to restore a normal heart rate. However, in many cases, medical intervention is required to stop the episode and prevent its recurrence.
The etiology of Paroxysmal Supraventricular Tachycardia (PSVT) refers to the underlying causes or factors that can lead to the development of this type of abnormal heart rhythm. PSVT is characterized by sudden and recurrent episodes of rapid heart rate, but its underlying causes can vary from person to person.
Accessory Pathways: One of the primary causes of PSVT is the presence of abnormal electrical pathways in the heart, often referred to as accessory pathways. These pathways allow electrical impulses to bypass the normal conduction system, leading to re-entrant tachycardias. Two common types of accessory pathways are the Kent bundle (associated with Wolff-Parkinson-White syndrome) and the Mahaim pathway.
Structural Heart Abnormalities: Certain structural abnormalities of the heart can predispose individuals to PSVT. These abnormalities may include congenital heart defects, enlarged atria, or scar tissue from previous heart surgery.
Caffeine and Stimulants: Excessive consumption of caffeine or other stimulants, such as certain medications or illicit drugs, can stimulate the heart and trigger PSVT episodes in susceptible individuals.
Alcohol: Some individuals may experience PSVT episodes after consuming alcohol. Alcohol can affect the heart’s electrical conduction system and increase the risk of arrhythmias.
Electrolyte Imbalances: Abnormal levels of electrolytes in the blood, such as potassium, sodium, and calcium, can disrupt the heart’s electrical activity and trigger PSVT.
PSVT can occur in individuals of any age, but certain risk factors may increase the likelihood of developing it. These risk factors include a family history of arrhythmias, heart disease, excessive caffeine or alcohol consumption, smoking, and stress. The hallmark sign of PSVT is a sudden and rapid heartbeat, often exceeding 100 to 150 beats per minute.
Due to the rapid heart rate, there may be inadequate blood flow to the brain. In severe cases, PSVT may lead to syncope or fainting episodes. Some individuals may experience chest pain or discomfort. The episodes of PSVT can vary in duration. They may last a few seconds to several hours and, in some cases, even longer. Most commonly, episodes resolve independently within a few minutes to hours, but some may require medical intervention to terminate.
The hallmark of PSVT is an abnormally fast heart rate, typically exceeding 150 to 200 beats per minute during an episode. Healthcare providers will check the pulse to assess the heart rate. Patients may report a sensation of rapid, strong, or irregular heartbeats, which is often described as palpitations. These can be felt by the patient or sometimes observed by the healthcare provider during the examination.
Some individuals may experience elevated blood pressure, while others may have normal or lower-than-normal blood pressure. This variation can depend on factors like the duration and frequency of the tachycardic episodes. During PSVT episodes, some individuals may appear pale or have cool, clammy skin due to decreased blood flow to the extremities. Patients may report various symptoms, such as dizziness, light-headedness, shortness of breath, chest discomfort, or syncope.
The examination may include an assessment of the jugular venous pressure in the neck, which can be elevated during PSVT episodes, particularly in cases with decreased blood flow from the heart. During PSVT, abnormal heart sounds such as a rapid, regular, or irregular rhythm may be heard. The absence of normal variations in heart sounds, like the “lub-dub” pattern, is a characteristic finding.
Atrial flutter
Atrial fibrillation
Atrial tachycardia
Intra-atrial reentrant tachycardia
Inappropriate sinus tachycardia
Sinoatrial node reentrant tachycardia
Junctional ectopic tachycardia
If the 12-lead ECG indicates an irregular rhythm with the absence of discernible P waves, the patient should be managed for atrial fibrillation. The patient should be treated for atrial flutter when the ECG displays an irregular rhythm with identifiable flutter waves. When the ECG reveals an irregular rhythm with multiple P wave morphologies, the patient should be managed for multifocal atrial tachycardia.
For patients with hemodynamic stability and a regular rhythm on the ECG but undetectable P waves, various interventions may aid in diagnosis and management. These can include Valsalva maneuvers, carotid sinus massage, intravenous adenosine administration, or altering the ECG paper speed from 25 mm per second to 50 mm per second.
If intravenous adenosine proves ineffective, healthcare providers may resort to intravenous or oral calcium channel blockers or beta-blockers to manage the condition. Additionally, patients with PSVT should undergo an evaluation to assess for any underlying pre-excitation syndrome. Those who do not respond to medical treatment or may be candidates for radiofrequency catheter ablation should receive a cardiology consultation.
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