Supra ventricular Tachycardia: A case report

S. Tina Antony Pragasi¹, M. Malathi², S. J. Sonya³, M. Arokiya Jaya Deepa⁴

¹Staff Nurse, MAA Kauvery Hospital, Trichy

²Ward Incharge, MAA Kauvery Hospital, Trichy

³Nursing Educator, MAA Kauvery Hospital, Trichy

⁴Nursing Superintendent, MAA Kauvery Hospital, Trichy

Background

In this article, we are going to discuss a child with supra ventricular tachycardia along with its clinical features, diagnosis, and management including its long-term aspects.

Supra ventricular tachycardia is the most common arrhythmia in pediatric patients presenting as a rapid heartbeat that originates at or above the atrioventricular (AV) node and is defined by a narrow complex (QRS < 120 milliseconds) at a rate > 100 beats per minute (bpm). It can occur in infants, children & adolescents with varying symptoms. If left untreated repeated episodes may lead to congestive heart failure from Tachycardia Cardiomyopathy, especially in younger patients.

Case presentation

A 2-year-old male child was admitted with complaints of fever, sweating and vomiting for 1 day and was noticed to have fast heartbeat while checking SpO₂/pulse using pulse oximeter at home. The pulse rate was 250 bpm. Then child was brought in to ER and ECG showed findings suggestive of SVT.

Fig: ECG before Adenosine

Impression

ECG showed narrow complex tachycardia at the rate of 230 bpm, there was an abnormal P-wave following QRS complexes.

Past Medical History

Baby known case of febrile seizures at the age of 1yr, and was on regular medication. There is no significant family history reported.

When baby got admitted here he was asymptomatic but heart rate was 240 beats per min. Rest of the parameters were within normal limits

Symptoms and Signs

Sweating, 1 episode of vomiting for 1 day and Tachycardia

Investigations

12 lead ECG (figure), CBC, serum Electrolytes, serum Calcium.

Blood investigation were normal including electrolytes.

Treatment

Started chemical cardio version, with intravenous Inj. Adenosine 0.1mg/kg, followed by 0.2mg/kg, followed by a push of 10ml normal saline along with carotid sinus massage. Rhythm reverted to normal sinus then for further cardiac monitoring baby shifted to PICU from ER.

Cardiologist opinion obtained. Echo was normal and Pocus- Echo examination revealed a distended inferior vena cava, and ejection fraction of 55–60%.

The baby was monitored in the critical care unit for two days then shifted to the ward. Continuous monitoring during the ward stay, for 48 hrs was done. Baby was started on oral propranolol and he had no further SVT episodes.

Then planned for electrophysiology and radiofrequency ablation after 5 years of age as per cardiologist advice. Discharged uneventfully.

Fig: ECG after Adenosine

Medication to be followed on discharge

Tab. Propranolol 10mg BD until review

Discussion

Supra ventricular tachycardia is a paroxysmal regular tachyarrhythmia that commonly involves the atrioventricular conduction system and an accessory AV pathway. This is the most frequent sustained dysrhythmia in children. A child may also experience the first episode at a higher age also.

Cause: SVT in children is often due to an accessory electrical pathway between the heart chambers

Clinical Manifestations

Sweating
Tachypnea
Irritability
Excessive crying
Palpitation
Chest discomfort

Diagnosis

Electro cardiogram
Holter monitor can be used for episodic monitoring

Distinguishing Between Supra Ventricular and Sinus Tachycardia

Criteria	SVT	Sinus tachycardia
Heart rate	>220bpm	>180 bpm
Heart rate variability	No marked variation	Marked variation
Surface ECG	P-wave absent or abnormal if present	P-wave present normal if detected
Identifiable cause	Not obvious	Obvious e.g. sepsis, fever

Management

At initial stage for stable patient vagal maneuver such as the Valsalva maneuver, carotid sinus massage can be initiated.
Pharmacological management: Adenosine is the first choice of medication for immediate result
For long-term treatment can be prescribed Beta-blockers or Anti arrhythmic drugs such as Amiodarone.
Advanced Intervention: Radio frequency Ablation
It is a curative option in recurrent or refractory cases.

How to give inj. Adenosine

Give by large peripheral or central vein, via the most proximal IV site possible.
It is highly recommended that whatever extremity in which adenosine is administered is elevated
After giving adenosine dose give 20ml of saline flush for rapid infusion.

Nurses Role in caring Supra ventricular tachycardia:

Monitor for irritability, feeding pattern, shortness of breathing, activity and chest discomfort.
Continuous cardiac monitoring may be required during acute episodes.
Initiate vagal maneuver in case of occurrence of episode.
Do not skip the regular medications.

Family Education

Educate the family members on recognizing symptoms of SVT.
Educate about triggers e.g., Fever, Dehydration, Stress.
Educate to continue medication regularly.
Advice to follow up regular review with cardiologist.

Ms. S. Tina Antony Pragasi
Staff Nurse

Ms. Sonya Mercy Anbu
Nurse Educator

Ms. Malathi M
Paediatric Ward Incharge

Ms. M. Arokiya Jaya Deepa
Nursing Superintendent

Supra ventricular Tachycardia: A case report

Supra ventricular Tachycardia: A case report

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