From the Guidelines
Paroxysmal Supraventricular Tachycardia (PSVT) is a clinical syndrome characterized by the presence of a regular and rapid tachycardia of abrupt onset and termination, and its management involves the use of adenosine or vagal maneuvers as the first-line treatment for acute episodes, as recommended by the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1.
Definition and Mechanism
PSVT is defined as a type of supraventricular tachycardia (SVT) that includes atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), and atrial tachycardia (AT) 1. The mechanism of PSVT involves the reentry of electrical impulses in the heart, which can be triggered by various factors such as stress, caffeine, or certain medications.
Diagnosis and Treatment
The diagnosis of PSVT is based on the clinical presentation and electrocardiogram (ECG) findings, which typically show a regular and rapid heart rate with a narrow QRS complex 1. The treatment of PSVT involves the use of adenosine or vagal maneuvers as the first-line treatment for acute episodes, followed by the use of calcium channel blockers or beta blockers for long-term management 1. In some cases, catheter ablation may be necessary to eliminate the underlying cause of the arrhythmia.
Key Points
- PSVT is a type of SVT that includes AVNRT, AVRT, and AT
- The mechanism of PSVT involves the reentry of electrical impulses in the heart
- The diagnosis of PSVT is based on clinical presentation and ECG findings
- The treatment of PSVT involves the use of adenosine or vagal maneuvers as the first-line treatment, followed by calcium channel blockers or beta blockers for long-term management
- Catheter ablation may be necessary in some cases to eliminate the underlying cause of the arrhythmia
Management of PSVT
The management of PSVT involves the following steps:
- Acute treatment: adenosine or vagal maneuvers as the first-line treatment
- Long-term management: calcium channel blockers or beta blockers
- Catheter ablation: may be necessary in some cases to eliminate the underlying cause of the arrhythmia
- Lifestyle modifications: stress reduction, avoidance of triggers such as caffeine and certain medications.
From the Research
Definition and Classification of Perinatal Stroke
- Perinatal stroke is a focal vascular brain injury that occurs from the fetal period to 28 days of postnatal age 2.
- It can be classified by the timing of diagnosis, vessel involvement, and type of injury, with recognizable subtypes including arterial and venous, ischemic, and/or hemorrhagic strokes 2, 3.
- Perinatal stroke diseases can be divided into six distinct categories based on clinical and radiographic features 2, 4.
Incidence and Prevalence of Perinatal Stroke
- The incidence of perinatal stroke is estimated to be between 1:1600 and 1:3000 live births, with approximately 2500 children per year affected in the United States 3.
- The birth-prevalence of perinatal stroke is reported to be 37-67/100,000, mostly in term-born infants 5.
Clinical Presentation and Outcomes of Perinatal Stroke
- Perinatal stroke can present with a range of symptoms, including seizures, motor asymmetry, and developmental delays 2, 5, 4.
- The consequences of perinatal stroke include cerebral palsy, epilepsy, cognitive and behavioral challenges, and psychosocial impact on families 2, 4.
- Outcomes can be predicted by the type and location of the stroke, with basal ganglia involvement associated with motor outcomes and cortical involvement associated with non-motor outcomes 6.
Management and Treatment of Perinatal Stroke
- Acute care for perinatal stroke relies on homeostatic maintenance, with seizures often self-limited and anticonvulsant agents potentially discontinued before discharge 5.
- Prolonged anticoagulation may be an option in some cases of sinovenous thrombosis 5.
- A multidisciplinary approach is required for the management of perinatal stroke, with a focus on minimizing brain injury and improving outcomes 2, 4.