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  • Supraventricular Tachycardia (SVT)Supraventricular Tachycardia (SVT)Supraventricular Tachycardia (SVT)Supraventricular Tachycardia (SVT)

    MUHAMMAD ALIMUHAMMAD ALIMUHAMMAD ALIMUHAMMAD ALI

  • Supraventricular Tachycardia (SVT)Supraventricular Tachycardia (SVT)Supraventricular Tachycardia (SVT)Supraventricular Tachycardia (SVT)

    SVT is characterized by rapid heart rates, usually 200 to

    300 beats/minute, with a QRS complex of normal

    duration

    Cardiovascular emergency in infant and children

    The incidence: 1/25,000-1/250

    Early detection and prompt treatment important

    Congestive heart failure

    Circulatory arrest

  • Mechanism of SVT

    Mechanism of SVT

    Automaticity Automaticity

    Reentry

  • Mechanism of SVT

    Automaticity Acceleration of phase 4 Source:

    Atrium AV junction His bundle Ventricle Pulmonary vein SVC

    Cause Metabolic disorder Hypoxia Hypokalemia Hypo magnesemia acidosis

  • Mechanism of SVT

    Reentry

    Condition

    Two pathway make closed closed circuit

    Block in 1 pathway

    Antegrad in normal conductionretrograd in block pathway

  • Mechanism of SVT

  • The episodes usually start and end abruptly

    Wolff-Parkinson-White (WPW) syndrome is

    responsible for about 50% of SVT in neonates

    Structural heart diseases (such as Ebstein's Structural heart diseases (such as Ebstein's

    Anomaly, Tricuspid Atresia, and cardiac tumors)

    are less frequent causes of SVT in neonates

    Viral myocarditis and thyrotoxicosis also have

    been associated with SVT

  • Short episodes of tachycardia usually do not harm the patient

    Newborns with sustained SVT become restless and Newborns with sustained SVT become restless and

    tachypneic with feeding difficulties and eventually develop

    signs of CHF and circulatory shock within 12 to 24 hours

    after onset

    Although rare, SVT diagnosed in utero may present with

    severe CHF at birth and has a high mortality rate, requiring

    prenatal treatment

  • TreatmentTreatmentTreatmentTreatment

    Adenosine is the treatment of choice, followed by digitalization

    Adenosine is given in a rapid intravenous bolus, starting at 50 g/kg, every 1 to 2 minutes (maximum, 250 g/kg)

    If the patient is unresponsive to adenosine and is in CHF, cardioversion may be performed, followed by digitalization and diuretics

    In SVT of short duration without signs of CHF, digoxin alone is used

    An ice bag applied to the face has been effective in some neonates

  • Vagal stimulatory maneuvers rarely are effective in neonates

    Transesophageal atrial overdrive stimulation may prove effective

    Verapamil and propranolol are not the drugs of choice

    Verapamil and propranolol are not the drugs of choice

    Tried only when other measures fail, and may produce extreme bradycardia and hypotension in a newborn; one should administer these drugs in a step-by-step dosage, monitor the infant carefully, and be prepared to resuscitate

  • Short-Term management

    of SVT

    Delacretaz. NEJM 2006;354:1039-51

  • THANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOU

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