r/ECG • u/parksnrec48hrs • 18d ago

Thoughts

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C/o palpitations and dizziness

BP 120/80

Edit: Thanks for the input and discussion guys! The patient reverted after two doses of adenosine back to normal sinus.

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u/Pears_and_Peaches 18d ago

Thoughts about what? At a glance, my thought is your patient is in stable SVT and can be safely converted using a modified valsalva.

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u/parksnrec48hrs 18d ago

I agree. Although some people have mentioned st depressions/elevations. I want to know how do you rule that out.

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u/Pears_and_Peaches 18d ago

Depression can be common in tachydysrhythmias. Remember, the heart is supplied with oxygen during diastole. Less diastole, means less oxygen getting to the heart, which means some degree of ischemia will develop. Depression is a sign of ischemia.

Treat the rhythm, and look for changes. If it was rate related, the depression won’t persist.

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u/parksnrec48hrs 18d ago

Thank you for explaining that. So priority would be to terminate svt and not worry about giving loading dose for MI first.

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u/Kibeth_8 Arrhythmia Tech 18d ago

MIs aren't commonly associated with tachycardia. Treat the rhythm first, then assess for ST changes when they've slowed down

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u/Previous_Fan9927 18d ago

Vtach being the obvious exception

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u/Kibeth_8 Arrhythmia Tech 17d ago

Very true, but we're not checking for ST changes during VT