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Supraventricular tachycardia — DIPIMC MCQ

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ModerateMedical EmergenciesSupraventricular tachycardiaDIPIMCDipIMC

A 35-year-old has palpitations and a regular narrow-complex tachycardia at 190 per minute. He is alert, with a blood pressure of 118/74 mmHg and no chest pain or breathlessness. Vagal manoeuvres have not worked. What is the most appropriate next step?

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Correct answer: E — Intravenous adenosine 6 mg as a rapid bolus with a flush

In a stable, regular narrow-complex tachycardia unresponsive to vagal manoeuvres, intravenous adenosine 6 mg as a rapid bolus with a saline flush is first-line, escalating to 12 mg if required. Synchronised cardioversion is reserved for the haemodynamically unstable patient. Combining verapamil with a beta-blocker risks dangerous bradycardia and hypotension. Pearl: warn the patient about the transient, unpleasant but brief flushing and chest tightness that adenosine produces.

Reference: Resuscitation Council UK Guidelines 2025 (Peri-arrest Arrhythmias); JRCALC Clinical Guidelines