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Paroxysmal supraventricular tachycardia — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsParoxysmal supraventricular tachycardiaSCE Acute Medicine

A 56-year-old woman presents with sudden palpitations. ECG shows a regular narrow-complex tachycardia at 184 bpm with no visible P waves. BP is 118/70 mmHg and there is no chest pain or heart failure. Modified Valsalva manoeuvre fails and she has no history of asthma or pre-excitation. What is the most appropriate next step in management?

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Correct answer: B — Give rapid intravenous adenosine with continuous ECG monitoring

Stable regular narrow-complex tachycardia after failed vagal manoeuvres should be treated with rapid IV adenosine while monitoring the ECG. DC cardioversion is reserved for instability or refractory arrhythmia. Verapamil may be considered in selected cases but is not first escalation here. Capturing the ECG response to adenosine can also reveal atrial flutter or atrial tachycardia.

Reference: Resuscitation Council UK tachycardia algorithm, BNF