Supraventricular Tachycardia Treatment within Hospital Care - Assignment Example

Title: Research Paper-Supraventricular Tachycardia Treatment within Hospital Care Name Course Tutor April 16th, 2013 Part A Introduction Supraventricular Tachycardia, most commonly abbreviated as SVT is a common complication of the cardiovascular system in Australia and around the entire globe. In most of the Australian populations, the first episodes of SVT are usually experienced during childhood or early adulthood (Colluci, Silver & Shubrook, 2010). According to Medi, Kalman & Freedman (2009 at pp.255), supraventrivular tachycardia refers to a range of conditions in which a trial tissue of the atrioventricular node is essential for sustaining what is usually the normal rate of the heart beat. Normally, this condition is associated with cardiac rhythm disturbance characterized by an abnormally fast beating of the heart. The heart beats at least 100 beats per minute and will even reach 300 beats per minute during an SVT episode (Medi, Kalman & Freedman, 2009). Risk Factors, Epidemiology and Patho physiology of SVT The many types of Supraventricular tachycardia have an estimated incidence 35 people in every 100,000 individuals even though the figure is still estimation. Although some types are most common in adults, others have been proved to be more common in children than in adults (Colluci, Silver & Shubrook, 2010, p. 942). The most common types of SVT’s occur as a result of re-entry of electrical aberrancies. They trigger the electrical activity of the heart thus increasing the heart beat above the normal rate (Colluci, Silver & Shubrook, 2010). The condition has become a common compliant in Australia even outside the hospital settings even though the number of people affected is still not yet known (Smith et al., 2012). Other common risk factors associated with the disease include addiction to large amounts of caffeine and alcohol, stress, emotional upset, medications such as inhalers and other cold remedies as well as bad smoking habits. SVT may also be prevalent among the aged and the old as compared to the other younger generations. Even though, young people who do not have heart diseases are also susceptible due to associated factors such as pneumonia (Al-Rawahi & Green, 2007). Types of Supraventricular Tachycardia The correct pre-hospital diagnosis and intervention of SVT depends on the correct identification of the type of the disease. According to Link (2012), one of the commonest types of SVT is Sinus Tachycardia. This type of the condition is usually slow and gradual both at the onset and when it is recessing. The heart rate of the patient is regular and does not exceed 220 beats per minute (Link, 2012, p. 1438). The most common causes of Sinus Tachy cardia are exercise, anger, stress, flight and fright (Al-Rawahi & Green, 2007, p. 23). Another common type of SVT is the atrial fibrillation. Indeed, it is the most common pathologic supraventricular tachycardia. This type of the disease has its own risk factors which include hypertension, any underlying heart conditions, the male sex and old age (Link, 2012, p. 1438). Atrial fibrillation is characterized by multiple electrical waves being present in the atria simultaneously. They take the form of waves that would be produced if several pebbles were dropped in a basin of water at the same time. SVT is said to be acute when it develops further spontaneously in a person with a normal heart beat rhythm (Link, 2012). Thirdly, we have the atrial flutter which is the second most common type of SVT and originated from a re-entrant circuit around the tricuspid valve in the right atrium. It is characterized by a rate of 280 beats to 300 beats per minute. The heartbeat is less regular most of the time for patients with this type of the disease even though it is less chaotic than in atrial fibrillation (Link, 2012, p. 1439). It is mostly prevalent in men, the elderly people as well as individuals who have a history of either structural heart disease or chronic obstructive lung disease (Medi, Kalman & Freedman, 2009). The other less common types include focal atrial tachycardia, multi-focal atrial tachycardia, the nodal atrioventricular re-entrant tachycardia (AVNRT) and the atrioventricular re-entrant tachycardia (AVRT) just but to mention a few (Al-Rawahi & Green, 2007, p. 22). The Signs and Symptoms of Supraventricular Tachycardia The signs and symptoms of SVT are almost similar in all the types. Additionally, they are dependent on a number of factors such as the age of the patient, the presence of other heart and lung diseases and the duration of the SVT episodes (Colluci, Silver & Shubrook, 2010). The most common symptom of the disease within the pre-hospital environment is a fast heart rate. This is the basic symptom for the indication that a patient may be suffering from the disease. The palpitations of the heart will increase to a rate faster than the normal rate. In normal cases, the rate will range between 140-200 beats per minute while in acute cases, the heart beat will go s high as 300 beats per minute. This may as well be life threatening (Colluci, Silver & Shubrook, 2010). More signs and symptoms of the disease include dizziness and feelings if light-headedness, breathlessness, anxiety and mild chest discomforts. Moreover, the patients may also exhibit signs of angina pain triggered by an episode of STV and a drop in the blood pressure due to the fast heart rate (Colluci, Silver & Shubrook, 2010). Low blood pressure may cause fainting especially in the elderly patients and those that have other heart and lung complications. Episodes may start suddenly and end in the same sudden way for no apparent reason. Some patients will not exhibit any symptoms apart from the abnormally fast heart rate. The Diagnostic Identification of SVT in the Pre-hospital and Hospital Settings The most common way in which SVT presents itself is by the racing heart beats. Especially in the pre-hospital setting, SVT could be easily diagnosed by racing palpitations, shortness of breath, discomforts and pains in the head as well as coughing, although in very rare cases. Other factors may include age. For instance, symptoms since early childhood are an indication of supraventricular tachycardia. The length of the episode may also play a factor. AVNRT will often start and stop quickly, while AVRT is gradual on the onset and offset (Colluci, Silver & Shubrook, 2010). Moreover, if the potential triggers of the episodes are mostly caffeine, stress, or reduced sleep, then it is more likely to be sinus tachycardia. Lastly, a patient with a history of heart complications is more likely to be suffering from a ventricular type of SVT (Colluci, Silver & Shubrook, 2010). However, physical examination out of the hospital may not be completely accurate in the differential diagnosis of the disease, thus necessitating hospital examination. Within the hospital setting an examination will be done in order to diagnose SVT. The initial differential diagnosis of SVT in the hospital must focus on the ventricular response as opposed to atrial depolarization (Link, 2012, p. 1444). It is important to use a systematic approach that will provide accurate information on the different types of SVT and their many instances of diagnoses (Josephson & Wellens, 1990). As noted earlier, the different types of differential diagnoses of SVT would be Sinus Tachycardia, Atrial Tachycardia, Atrial flutter, Atrioventricular re-entrant tachycardia(AVRT) and Atrioventricular nodal re-entrant tachycardia (AVNRT) among others (Varosy, 2008). The first step involves determining whether the QRS complex is narrow and wide, which is then followed by an assessment of the regularity of the heart rate (Link, 2012). Subsequently, the rapidity of the heart rate is determined both at the onset of an episode of SVT and at its offset. This is done by monitoring the cardiac system of the patient as well as the heart rate. It is also pertinent to assess the heart rate of the patient on the basis of history. This will help the doctor track the atrial activity of the heart and thus arrive at a viable conclusion as regard to the differential diagnoses of SVT. It is a very crucial aspect of differential diagnosis of wide-complex tachycardia since it is the first step in determining which type of SVT is the cause of the symptoms (Link, 2012, p. 1446). If the patient has a suspected history of any cardiac disease, then the probability of a ventricular tachycardia is high, and treatment should be immediately initiated. In a nutshell, the history may reveal the likely aetiology underlying the SVT (Colluci, Silver & Shubrook, 2010). Medications that may assist in Differential Diagnosis of SVT Importantly, the administration of particular drugs such as adenosine may also assist in the diagnosis and identification of a specific type of SVT. Adenosine is particularly administered in the case of wide-complex tachycardia since it helps in terminating many of the symptoms of SVT. It is useful in the differential diagnosis of wide-complex tachycardia but should only be administered when they are irregular (Link, 2012, p. 1445). It can be both diagnostic and therapeutic (Colluci, Silver & Shubrook, 2010). It is essentially useful because it helps to bring out the flutter waves in A-flutter and the P-waves in Focal atrial tachycardia (Varosy, 2008). Alternatively, intravenous administration of verapamil and diltiazem can be potentially helpful in the differential diagnostic of SVT. Verapamil is a channel blocker that could also be used both for diagnostic purposes and for treatment purposes. It could importantly be used in diagnosing sinus tachycardia which is characterized by visible P-waves and has short interval episodes (Colluci, Silver & Shubrook, 2010). Other interventions include electrical cardioversion, especially for patients who do not respond to adenosine (Link, 2012). Part B The Pre hospital Management of Supra-ventricular Tachycardia Even outside the hospital, SVT is capable of being managed (Smith et al., 2012). Many episodes of the disease start and stop on their own. But sometimes, it is possible to stop an SVT episode by employing various measures. There exists a wide range of interventions that will help in the management of the condition out of the hospital setting. There is a lot of published literature which demonstrates a range of these interventions and the techniques that may be used to terminate an SVT episode. The pre-hospital interventions used within Australia and internationally to treat this condition thus include basic interventions such as drinking a glass of water and breathe holding (Colluci, Silver & Shubrook, 2010). They are also called human drive reflective management procedures and will be discussed in details below. The most common intervention in the treatment of SVT in the pre-hospital setting is the use of vagal manoeuvres (Smith et al., 2012). It is the first line treatment for SVT in any pre-hospital setting. In this process, the person attempts to provide an initial attempt to terminate the episode of SVT. It is the major pre-cursor to pharmacological interventions. It is also predominantly important because it allows paramedics to avoid some of the side effects of drugs since these are not administered to the patient (Smith et al., 2012, p. 611). As a matter of fact, posture is very important in these vagal manoeuvres. The valsava manoeuvre for instance, uses what is referred to as supine posture so as to protect against hypotension (Medi, Kalman & Freedman, 2009). On the other hand, an upright posture must be avoided at all costs as it may precipitate the SVT. It is therefore of paramount importance that the person administering the intervention must ascertain that the patient has adopted a supine posture (Wang & Estes, 2002). Subsequently, the use of cold stimulus on the face may also help in the termination of an SVT episode especially in the home setting. It may take the version of total immersion of the patients face in ice cold water (Colluci, Silver & Shubrook, 2010). A cold stimulus is said to increase the vagal tone. However, this requires the use of a cold stimulus that is readily available and thus would entail items such as cold water or ice (Medi, Kalman & Freedman, 2009). These two are particularly recommended since they can withstand the speed of a very fast moving environment like that of an ambulance. This is what justifies the recommendation to use a cold stimulus in the pre hospital setting and particularly for the management of SVT. Furedy et al., (1983) also recommend the use of the cold stimulus in the pre hospital management of SVT. Another important component of the interventions that are used in Australia and also internationally in the pre hospital care for an SVT is the aspect of breath holding. In essence, breath holding is very crucial. But caution should be taken when both this and the cold stimulus are used (Smith et al., 2012, p. 612). This is because the nature of the cold stimulus may at times require the obstruction of the mouth and the nose for the period of the manoeuvre. Consequently, there is no evidence that has yet been published on the consequences that these may have on the respiratory cycle of the patient (Furedy, 1983). The changes on the respiratory cycle during this phase may include a very deep inhalation followed by a complete exhalation and maybe a neutral point in between. Moreover, it may influence the effectiveness of the intervention because of the increased vagal tone brought about by the generation of the deep inspiration (Furedy, 1983, p. 573). The cold stimulus intervention has also been discredited because it has been noted to stimulate certain pain fibres and a sympathetic response. Since the water or ice is below 5°C, it is likely to have an effect on the physiological responses of the patient. This specifically, may prove to be counterproductive to the main objective of the intervention (Furedy, 1983). It may lengthen the duration of the SVT episode or even reverse the results of the whole procedure. Furedy et al., (1983) also questions the potential impact of the ambient extremely low temperature of the cold stimulus as well as its later effect on the clinical setting. The authors note that its variable effect in the hospital setting although not yet established still remains unknown. Moreover, the use of this intervention in the pre hospital management of SVT is still not completely recommended. Notably, it has raised concerns about its appropriateness especially when used to manage patients especially those who are located in the very rural and remote areas (Smith et al., 2012, p. 613). For them, the cold stimuli intervention may not be so effective since it may eventually become less cold with the long transport distances required to reach them to hospitals. It is thus impossible to maintain it at a specific temperature. It then becomes very imminent that a new device ought to be devised that can demonstrate long usage and long periods of storage and at the same time being cost effective (Smith et al., 2012). It is also discredited for the fact that a cold stimulus intervention has been feared to trigger involuntary apnoea especially in children. In addition, that the procedure is likely to raise the levels of anxiety for patients with associated heart complications. Subsequently, a heightened anxiety response is more likely to produce other side effects like a rise in the blood pressure of the patient and reduced effectiveness of the patient (Colluci, Silver & Shubrook, 2010, p. 948). Notably, substantial and effective use of pre hospital measures in the management of SVT could also be realized within a realistic continuum of care (Smith et al., 2012, p. 614). The studies suggested that it can be elicited in the ways elaborated above. However, the environment where such care is given also plays a major factor. The environment should ideally be optimal for the both the patient and care giver with regards to factors such as safety and equipment and hazard control (Smith et al., 2012, p. 614). For instance, the administration of the cold stimuli requires a room with normal ambient temperatures as very high temperatures will definitely tamper with the same. If it is at night, it also requires adequate lighting which would in turn ensure continuous cardiac monitoring and effective administration of the intervention (Rourke, Savage & Evans, 2004, p. 495). It is also essential for the care giver to ensure that the administration of first line resuscitation drugs is kept to the minimum since drugs here become the last option. Moreover, oxygen and mechanical ventilation devices should be available and within reach just in case of any emergencies (Smith et al., 2012). The overall safety of the procedure is also paramount as regards the aspect of continuum of care. Notably, the care giver must ensure that all risks and hazardous possibilities are eliminated by all means (Smith et al., 2012). The main goal of pre hospital interventions is to terminate an SVT episode. If in case there is reoccurrence of the arrhythmia, same care and precaution should be administered by the person giving the intervention as well as the receiver. It would also be prudent to ensure that after the physical examination, no physical injury has developed as a result of the application of the cold stimulus (Wang & Estes, 2002). From the foregoing, it is thus only laudable to assert that the pre hospital treatment of SVT is a very crucial aspect in its management. It is only when the SVT episode lasts longer than usual that admission into the hospital may be necessary (Rourke, Savage & Evans, 2004, p. 497). As a matter fact, treatment is only generally recommended for atrial tachycardia if it is causing the patient a lot of symptoms. But due to the paucity and the limits of research in this area, no much conclusions can be drawn yet on the effectiveness of pre hospital care and management of SVT. Notwithstanding this fact, it still remains that facial immersion of the face in iced cold water, a cold stimulus and breath holding are some of the best interventions for the pre hospital management of SVT as it stands now (Smith et al., 2012). Conclusion The paper herein has explicitly elaborated on Supraventricular Tachycardia, abbreviated as SVT. It is condition is associated with cardiac rhythm disturbance characterized by an abnormally fast beating of the heart. It has many types and become a common compliant both in Australia and around the globe. The risk factors of this condition include addiction to large amounts of caffeine and alcohol, stress, emotional upset, medications such as inhalers and other cold remedies and bad smoking habits. SVT is also prevalent among the aged and the old. The signs and symptoms include dizziness, light-headedness, breathlessness, anxiety, a fast heart rate and mild chest discomforts. Moreover, the patients may also exhibit signs of angina pain triggered by an episode of STV and a drop in the blood pressure due to the fast heart rate (Colluci, Silver & Shubrook, 2010). Notably, the differential diagnosis of this disease is also very paramount as discussed above. In spite of the many hospital interventions available to remedy this condition, other pre hospital interventions also exist. they are facial immersion of the face in iced cold water, a cold stimulus and breath holding and still remain as some of the best interventions for the pre hospital management of SVT as it stands now (Smith et al., 2012). Together with a well defined continuum of care, it would only thus only laudable to assert that the pre hospital treatment of SVT is a very crucial aspect in SVT management. Works Cited Al-Rawahi, N., & Green, M. S. (2007). Diagnosis of supraventricular tachycardia. The Journal of the Association of Physicians of India; vol. 55, pp.21-4. Retrieved from http://japi.org/april2007/suppliment/Suppliment_21-24.pdf Colucci, R. A., Silver, M. J., & Shubrook, J. (January 01, 2010). Common types of supraventricular tachycardia: diagnosis and management. American Family Physician, 82, 8, pp. 942-52. Furedy J. J et al., (1983) Effects of water temperature on some noninvasively measured components of the human dive reflex: an experimental response-topography analysis. Psychophysiology: Vol 20; pp. 569–78. Gausche, M., Persse, D. E., Sugarman, T., Shea, S. R., Palmer, G. L., Lewis, R. J., Brueske, P. J (1994). Adenosine for the prehospital treatment of paroxysmal supraventricular tachycardia. Annals of Emergency Medicine, 24, 2, pp.183-9. Josephson, M. E., & Wellens, H. J. (1990). Differential diagnosis of supraventricular tachycardia. Cardiology Clinics, 8, 3, pp. 411-42. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2205383 Link, M. S. (2012). Evaluation and Initial Treatment of Supraventricular Tachycardia. New England Journal of Medicine, 367, vol. 15, pp. 1438-1448. Retrieved from http://www.nejm.org/doi/pdf/10.1056/NEJMcp1111259 Medi, C., Kalman, J. M., & Freedman, S. B. (2009). REVIEW - Supraventricular tachycardia. The Medical Journal of Australia, 190, vol 5, pp. 255. Retrieved from https://www.mja.com.au/journal/2009/190/5/supraventricular-tachycardia Rourke O. S. F., Sauvage, A., & Evans, P. A. (2004). Paroxysmal supraventricular tachycardia: improving diagnosis and management within the accident and emergency department. Emergency Medicine Journal, 21, vol 4, pp. 495-497. Retrieved from http://emj.bmj.com/content/21/4/495.full Smith, G., Morgans, A., Taylor, D. M., & Cameron, P. (2012). Use of the human dive reflex for the management of supraventricular tachycardia: a review of the literature. Emergency Medicine Journal : Emj, 29, 8, pp. 611-6. Retrieved from http://emj.bmj.com/content/early/2012/03/02/emermed-2011-200877.full Varosy D. P,(2008). Supraventricular Tachycardia: R 1 Half Day. Retrieved from http://sfgh.medicine.ucsf.edu/education/resed/intern_half_day/pdf/svt.pdf Wang, P. J., & Estes, N. A. (2002). Cardiology patient pages. Supraventricular tachycardia. Circulation; 106, vol. 25, pp. 206-8. 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