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Supraventricular Tachycardia (SVT) — UKMLA MCQ

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MediumCardiologySupraventricular Tachycardia (SVT)UKMLAMRCP Part 1MRCEM SBAPARA

A 29-year-old woman presents with palpitations and light-headedness. Her ECG shows a regular narrow complex tachycardia at a rate of 180 bpm. P waves are not clearly visible. Vagal manoeuvres (Valsalva) are unsuccessful in terminating the rhythm. She is haemodynamically stable. According to Resuscitation Council UK guidelines, what is the most appropriate next pharmacological treatment?

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Correct answer: C — Adenosine 6mg rapid IV bolus

This ECG describes a regular narrow complex tachycardia, most likely Supraventricular Tachycardia (SVT), often AV-nodal re-entrant tachycardia (AVNRT) or AV re-entrant tachycardia (AVRT). Resuscitation Council UK guidelines for stable narrow complex tachycardia recommend attempting vagal manoeuvres first. If unsuccessful, the first-line pharmacological treatment is Adenosine given as a rapid IV bolus (initial dose 6mg, followed by 12mg if needed). Verapamil (Option B) is a second-line option if adenosine is contraindicated or ineffective (use with caution if diagnosis uncertain, avoid in wide-complex tachycardia or if beta-blockers given). Amiodarone (Option C) is generally reserved for resistant cases or specific situations. Beta-blockers (Option D) or Digoxin (Option E) are less commonly used acutely for termination, more for rate control.

Reference: Resuscitation Council UK: Adult tachycardia algorithm