A&E

Hospital Lahad Datu

PPP Cyril
BPP2014-2206

Patients Hx

Female, 52yrs, Dusun

c/o: SOB x 1/7
a/w chest pain, sweating, dizziness, palpitation
No fever, no vomitting

Past Medical Hx

Hx of PTB(2003) complete Tx
Hypertension,Bronchiol Asthma,Gout
Medications:

-Tab. Allopurinol 150mg OD

-Tab. Amlodipine 10mg OD
-Tab. Valsartan 120mg BD
-MDI Salbutamol 200mcg PRN
-MDI Budesonide 160mcg/4.5mcg

 No known drug allergy

No known food allergy
No history of surgical

Family Hx

Father Ischemic heart disease,

hypertension
Son- Congenital heart disease

Social Hx
No hx of smoking
No hx of alcohol abuse
No hx of drug abuse
O&G Hx
Menopause
No Hx of LSCS

Examination

General Examination:
Walking, alert, pink, hydration fair, CRT<2s
O/e:
BP- 110/70 mmHg
PR- 225bpm
RR-26
SpO2-98%
Temp-36.8

Fully examination:
CVS- DRNM(fast beats)
Respiratory-Clear
Abdomen-Soft

Investigations:
ECG-Pre Verapamil

Post Verapamil:

Investigations
Full Blood Count:
i. WBC-11.1 (4-11)x 10 9/L
ii. RBC- 4 (3.9-5.6) x 10 12/L
iii. Hb-11 (11.5-16)g/dL
iv. Platelet-473 (150-400) x 10 9/L
Buse/Creat:
1. Na- 136 mmol/L
2. K-4.1 mmol/L
3. Urea-3.6 mmol/L
4. Creatinine-87 umol/L
5. Creatine Kinase-56 u/L

 Chest X-ray:
i.
Normal Heart
ii.
Right lung fibrosis(due to PTB)
Cardiac Enzymes

Diagnosis:
Impression/Dx:
Supraventricular Tachycardia
Differential Diagnosis:
a) Ventricular Tachycardia
b) Sinus node Dysfunction
c) Fast Atrial Fibrillation

Management and Treatments:

A&E
1.
2.
3.
4.

Triage Patient- Red Zone

Asses patient respond-alert, conscious
Check airway(block)
Breathing- Prop up patient
- Give O2 via Nasal Prong 3L/hour
5. Circulation - Set line (brachial) -Iv drip NS 5pint@24
hours
- Take all blood investigation
6. Carotids massage & Vasalva maneuver
7.
Medication: IV Verapamil 2.5mg stat
Pre Verapamil(225bpm)Post
Verapamil(89bpm)

8. Nursing Care
Close v/s monitoring every 30mins
Cardiac monitoring
Serial ECG
9. Health Education:
- Take medication as prescribed
Healthy diet
Exercise
Follow up examination

SVT/PSVT
Abnormal heart rhythm arising from
electrical activity of the heart
Type of rapid heart rhythm originating at or
above the AV node.

Etiology

Reentry mechanism
Hyperthyroidism
Caffeine
Drugs
Alcohol
Previous MI
Mitral valve prolapse
Rheumatic heart disease
Pericarditis
Lung diseases
Digoxin toxicity
Exercise

Types
AV nodal reentrant tachycardia(AVNRT)
AV reentrant tachycardia(AVRT)

AVNRT
Common causes of SVT (50-60%)
Women > men

Pathophysiology

AVRT

Uncommon cases(0.1-0.3%)
Mens > womens

Pathophysiology

Sign and symptoms

Palpitations
Dizziness
SOB
Syncope
Chest pain
Fatigue
Diaphoresis
Nausea

Investigations

ECG
FBC
BUSE/Creat
Cardiac Enzymes
Chest X-ray

Management
Medications
I. Adenosine 3mg/mL
II. Verapamil 2.5mg/mL
III. Amiodarone 50mg/mL
Sync Cardioversion
Health Educations
Vagal Maneuver
I. Vasalva Maneuver

Tq
The End