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Paroxysmal supraventricular tachycardia: improving diagnosis and management within the accident and emergency department.

ABSTRACT: Accident and emergency (A&E) senior house offices (SHOs) have difficulties in interpreting the electrocardiogram (ECG) in narrow complex tachycardia. Correct ECG interpretation is fundamental to patient management in paroxysmal supraventricular tachycardia. This study aimed to assess the ability of A&E SHOs to interpret the ECG in this setting. Correct diagnosis in 63% of cases improved to 86% with the introduction of a standard protocol sheet. Ensuring that SHOs follow agreed guidelines in rhythm recognition and management of PSVT improves patient care.

SUBMITTER: O'Rourke SF

PROVIDER: S-EPMC1726368 | biostudies-literature | 2004 Jul

REPOSITORIES: biostudies-literature

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Paroxysmal supraventricular tachycardia: improving diagnosis and management within the accident and emergency department.

O'Rourke S F SF Sauvage A A Evans P A PA

Emergency medicine journal : EMJ 20040701 4

Accident and emergency (A&E) senior house offices (SHOs) have difficulties in interpreting the electrocardiogram (ECG) in narrow complex tachycardia. Correct ECG interpretation is fundamental to patient management in paroxysmal supraventricular tachycardia. This study aimed to assess the ability of A&E SHOs to interpret the ECG in this setting. Correct diagnosis in 63% of cases improved to 86% with the introduction of a standard protocol sheet. Ensuring that SHOs follow agreed guidelines in rhyt ...[more]

PMID: 15208240

Similar Datasets

Hospitalization rate of paroxysmal supraventricular tachycardia in Sweden.

Project description:IntroductionThe hospitalization rate of paroxysmal supraventricular tachycardia (PSVT) in a nationwide study is not established. We determined age- and sex-specific hospitalization rates and time trends for hospitalized PSVT in the Swedish population between 1987 and 2010.MethodsThis nationwide study is based on the Swedish Hospital Discharge Register. The patients with first PSVT diagnoses between January 1987 and December 2010 were identified.ResultsA total of 42,765 individuals with PSVT were diagnosed (mean age 60 years; 44% males). The overall age- and sex-adjusted hospitalization rate was 20 per 100,000 person-years. The hospitalization rate increased with advancing age with highest hospitalization rates in individuals aged 80-84 years (67.12 per 100,000 person-years) and did not change significantly over time. A total of 20,011 (46.8%) patients had "lone" PSVT without any comorbidities. Lone PSVT patients were younger than PSVT patients with comorbidities (mean age 54 vs. 67 years, p = .0002).ConclusionsThis study showed a slight preponderance for females and stable hospitalization rate of PSVT over time; the hospitalization rate increased with age. A high proportion of PSVT patients had no comorbidities. They were affected at a younger age than patients with comorbidities, which suggests an inherent predisposition. Key messages This study represents the first extensive and nationwide hospitalization study of PSVT. Hospitalization is highest in old age but a bimodal pattern was observed with a small peak in the first years of life. Patients with lone PSVT are younger than those with comorbidities; which suggests an inherent predisposition.

| S-EPMC6441476 | biostudies-literature

Paroxysmal supraventricular tachycardia and the risk of ischemic stroke.

Project description:It is unknown whether supraventricular arrhythmias other than atrial fibrillation or flutter are associated with stroke.To examine the association between paroxysmal supraventricular tachycardia (PSVT) and stroke, we performed a retrospective cohort study using administrative claims data from all emergency department encounters and hospitalizations at California's nonfederal acute care hospitals in 2009. Our cohort comprised all adult patients with ? 1 emergency department visit or hospitalization from which they were discharged alive and without a diagnosis of stroke. Our primary exposure was a diagnosis of PSVT recorded at an encounter before stroke or documented as present-on-admission at the time of stroke. To reduce confounding, we excluded patients with diagnoses of atrial fibrillation. We defined PSVT, stroke, and atrial fibrillation using International Classification of Diseases, Ninth Revision, Clinical Modification codes previously validated by detailed chart review.Of 4 806 830 eligible patients, 14 121 (0.29%) were diagnosed with PSVT and 14 402 (0.30%) experienced a stroke. The cumulative rate of stroke after PSVT diagnosis (0.94%; 95% confidence interval, 0.76%-1.16%) significantly exceeded the rate among patients without a diagnosis of PSVT (0.21%; 95% confidence interval, 0.21%-0.22%). In Cox proportional hazards analysis controlling for demographic characteristics and potential confounders, PSVT was independently associated with a higher risk of subsequent stroke (hazard ratio, 2.10; 95% confidence interval, 1.69-2.62).In a large and demographically diverse sample of patients, we found an independent association between PSVT and ischemic stroke. PSVT seems to be a novel risk factor that may account for some proportion of strokes that are currently classified as cryptogenic.

| S-EPMC3950597 | biostudies-literature

Disparities in the Management of Newly Diagnosed Paroxysmal Supraventricular Tachycardia for Women Versus Men in the United States.

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| S-EPMC7792362 | biostudies-literature

The management of ureteric stones in the Accident and Emergency department.

Project description:Ureteric stones is a common cause for attendance to the A&E department. Active or conservative management is delivered dependent on the relevant history, clinical condition, and investigation results. The majority of patients can be treated conservatively and do not require admission. However, some cases of ureteric stones present as a urological emergency if, for example, there is an infected obstructed system. An initial audit over a two month period of A&E admissions with radiologically proven ureteric stones demonstrated there was no easily accessible, specific criteria used to guide which patients were admitted and which patients were discharged from A&E. Therefore, an admission criteria and discharge proforma was developed and implemented in the A&E department to ensure patients were appropriately discharged if they could be managed conservatively and appropriately admitted if they potentially required further observation and intervention. A repeat audit using the same methods and criteria was carried out and demonstrated fewer unnecessary admissions and fewer inappropriate discharges.

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Anterior mitral leaflet perforation: a rare complication of radiofrequency ablation for paroxysmal supraventricular tachycardia.

Project description:A 9-year-old girl with a ten-day history of palpitations was referred for the assessment of mitral regurgitation. She had had RF ablation for paroxysmal supraventricular tachycardia 5 years previously. Echocardiography showed isolated anterior mitral leaflet perforation. Surgical findings confirmed the echocardiographic assessment.

| S-EPMC5538059 | biostudies-other

Paroxysmal supraventricular tachycardia and risk of ischemic stroke: A systematic review and meta-analysis.

Project description:BackgroundParoxysmal supraventricular tachycardia (PSVT) has been traditionally considered as a benign rhythm disorder. However, recent studies have suggested that patients with PSVT may have a higher risk of ischemic stroke although the data are limited and inconclusive. The current systematic review and meta-analysis was conducted with the aims to identify all available studies and summarize their results together to better characterize the risk of ischemic stroke among patients with PSVT.MethodsA comprehensive literature review was conducted by searching for published articles indexed in MEDLINE and EMBASE databases from inception through November 11, 2018 to identify all observational studies that compared the risk of ischemic stroke between patients with PSVT and individuals without PSVT. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird.ResultsA total 5 studies (4 cohort studies and 1 case-control study) with 4 886 977 participants met the eligibility criteria and were included into the meta-analysis. The risk of ischemic stroke among patients with PSVT was significantly higher than individuals without PSVT with the pooled RR of 2.03 (95% CI, 1.22-3.38, I 2 = 89%).ConclusionThis study found that PSVT is associated with a higher risk of ischemic stroke. Whether this association is causal and how it should be addressed in clinical practice require further investigations.

| S-EPMC6595320 | biostudies-literature

Outcomes of deep sedation for catheter ablation of paroxysmal supraventricular tachycardia, with adaptive servo ventilation.

Project description:BackgroundCatheter ablation for paroxysmal supraventricular tachycardia (PSVT) is an established treatment, but the effect of deep sedation on PSVT inducibility remains unclear.AimWe sought to examine PSVT inducibility and outcomes of catheter ablation under deep sedation using adaptive servo ventilation (ASV).MethodsWe retrospectively evaluated consecutive patients who underwent catheter ablation for PSVT under deep sedation (Propofol + Dexmedetomidine) with use of ASV. Anesthetic depth was controlled with BIS™ monitoring, and phenylephrine was administered to prevent anesthesia-induced hypotension. PSVT induction was attempted in all patients using extrastimuli at baseline, and after isoproterenol (ISP) infusion when necessary.ResultsPSVT was successfully induced in 145 of 147 patients, although ISP infusion was required in the majority (89%). The PSVT was atrioventricular nodal reentrant tachycardia (AVNRT) in 77 (53%), atrioventricular reciprocating tachycardia (AVRT) in 51 (35%), and atrial tachycardia (AT) in 17 (12%). A higher ISP dose was required for AT compared to other PSVT (AVNRT: 0.06 (IQR 0.03-0.06) vs AVRT: 0.03 (0.02-0.06) vs AT: 0.06 (0.03-0.12) mg/h, P = .013). More than half (51%) of the patients developed hypotension requiring phenylephrine; these patients were older. Acute success was obtained in 99% (patients with AVNRT had endpoints with single echo on ISP in 46%). Long-term success rate was 136 of 144 (94%) (AVNRT 96%, AVRT 92%, and AT 93%). There were no complications related to deep sedation.ConclusionsDeep sedation with use of ASV is a feasible anesthesia strategy for catheter ablation of PSVT with good long-term outcome. PSVT remains inducible if ISP is used.

| S-EPMC7896470 | biostudies-literature

Update on Etripamil Nasal Spray for the At-home Treatment of Acute Paroxysmal Supraventricular Tachycardia.

Project description:The current treatment of sustained paroxysmal supraventricular tachycardia (PSVT) often requires attendance at a medical facility. This burden is driven by the lack of an effective self-administered treatment for PSVT. Etripamil (Milestone Pharmaceuticals, Saint-Laurent, QC, Canada) is a novel intra-nasal preparation of a rapidly effective but short-acting calcium-channel blocker, which shows promise in offering out-of-hospital treatment for patients with PSVT. Studies, to date, have demonstrated good tolerability and potential efficacy, with a safety profile that is acceptable for unsupervised self-administration. This article reviews the current epidemiology and international guidelines for the treatment of acute PSVT, the pharmacology and clinical trial evidence behind the novel agent etripamil, and considers its potential role in the management of patients with PSVT.

| S-EPMC9524608 | biostudies-literature

Improving the diagnosis of pulmonary embolism in the emergency department.

Project description:The diagnosis of pulmonary embolism (PE) in the emergency department is challenging due to the wide range of non-specific symptoms, lack of clinical diagnostic criteria, and imperfect investigations. Various scoring systems exist in an attempt to limit unnecessary investigations in those with low risk of PE. Following a baseline audit and subsequent PDSA cycles we implemented a flowchart for use in patients suspected of pulmonary embolism encouraging the correct use of the Wells Score and Pulmonary Embolism Rule out Criteria (PERC). The standard used for comparison was based on the NICE guidelines for diagnosis of PE with the addition that PERC could also be used if appropriate. Data was collected over four week periods before and after the introduction of our flowchart in two emergency departments in Melbourne. We aimed to increase documentation of pre-test probability, reduce inappropriate investigations, and increase the use of interim parenteral anticoagulation where there was a delay to imaging. Results showed an increase in the documentation of pre-test probability and the proportion of investigations requested that were inappropriate was reduced. The percentage of inappropriate d-dimers was reduced from 36% to 24%; the percentage of inappropriate CTPAs was reduced from 34% to 10%; and the percentage of inappropriate V/Q scans was reduced from 42% to 14%. Implementation of a simple diagnostic algorithm led to an increase in documentation of pre-test probability and a reduction in inappropriate and unnecessary investigations. This intervention may be applicable to other emergency departments where similar issues in diagnosing pulmonary embolism exist.

| S-EPMC4752702 | biostudies-literature

Validation of physiological scoring systems in the accident and emergency department.

Project description:BackgroundScoring systems that weigh the degree of abnormality of bedside observations might be able to identify patients at risk of catastrophic deterioration.ObjectivesTo establish a frequency distribution for typical physiological scoring systems and to establish the potential benefit of adding these to an existing triage system in accident and emergency departments.MethodsPhysiological data were collected from 53 unselected emergency department admissions, from 50 patients admitted from the emergency department to intensive care, and from 50 patients admitted from emergency department to general wards and then to intensive care. Three different physiological scores were calculated from the data. Identification of sick patients by the scores was compared with triage information from the Manchester Triage System (MTS).ResultsMost patients admitted to the emergency department would not be identified as critically ill with the aid of physiological scoring systems. This was true even for patients who were admitted to intensive care. Only in 0-8% of unselected patients did the scores indicate increased risk. In 100 patients admitted to the intensive care, adding of medical emergency team call-out criteria, Modified Early Warning Score or Assessment Score for Sick patient Identification and Step-up in Treatment would identify none, seven or one patient in addition to those triaged as orange and red by the MTS.ConclusionsIntroduction of a physiological scoring system would have identified only a small number of additional patients as critically ill and added little to the triage system currently in use.

| S-EPMC2464409 | biostudies-literature

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