Supraventricular Tachycardia

Supraventricular Tachycardia is a topic covered in the 5-Minute Emergency Consult.

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  • Rhythm that originates ectopically above the His bundle
  • Heart rate of 100 bpm or greater
  • Irregular narrow complex supraventricular tachycardia (SVT):
    • Atrial fibrillation (AF):
      • Most common form of pathologic SVT seen in the ED
      • 10% of people >75 yr of age have AF.
    • Atrial flutter with variable block
    • Multifocal atrial tachycardia
  • Regular narrow complex SVT:
    • Atrial flutter
    • Atrioventricular nodal re-entry tachycardia (AVNRT):
      • 60% of SVT in adults, 70% are female
      • Typically present age 30–40 yr
    • Atrioventricular reciprocating tachycardia (AVRT) involving an accessory pathway
  • Wide complex SVT:
    • Conduction is outside of the normal His-Purkinje system.
    • Accessory pathway or a bundle branch block is present.
    • More common in younger patients without structural disease
    • Always suspect a ventricular rhythm with a wide complex rhythm
    • Treat as ventricular tachycardia (VT) unless absolutely certain of SVT


  • Atrial tachycardia:
    • Precipitated by a premature atrial or ventricular contraction
    • Electrolyte disturbances
    • Drug toxicity (i.e., theophylline)
    • Hypoxia
    • Increased atrial pressure
  • Junctional tachycardia:
    • AV nodal re-entry
    • Myocardial ischemia
    • Structural heart disease
    • Pre-excitation syndromes
  • Wolff–Parkinson–White (WPW) syndrome:
    • Intrinsic accessory pathway
    • Drug and alcohol toxicity
  • AF:
    • HTN
    • Coronary artery disease
    • Hypo-/hyperthyroidism
    • Heavy alcohol intake
    • Mitral valve disease
    • Chronic pulmonary disease
    • Pulmonary embolus
    • WPW syndrome
    • Hypoxia
    • Digoxin toxicity
    • Chronic pericarditis
    • Sepsis
  • Atrial flutter:
    • Ischemic heart disease
    • Valvular heart diseases
    • CHF
    • Myocarditis
    • Cardiomyopathies
    • Pulmonary embolus
    • Other pulmonary disease

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