Dr. Sunain Ashraf
 SVT

any tachyarrhythmia that requires atrial
and/or atrioventricular (AV) nodal tissue for
its initiation and maintenan...
 Depending

on the site of origin of the
dysrhythmia, SVTs may be classified as an
atrial or AV tachyarrhythmia.
Atrial tachyarrhythmias
• (1) sinus tachycardia
• (2) inappropriate sinus tachycardia (IST)
• (3) sinus nodal reentrant ta...
AV tachyarrhythmias
• (1) AV nodal reentrant tachycardia (AVNRT)
• (2) AV reentrant tachycardia (AVRT)
• (3)junctional ect...
AV Tachyarrhythmias
 most

common cause of paroxysmal
supraventricular tachycardia is AVNRT.
 AVNRT is diagnosed in 50-60% of present with
...
 AVNRT



healthy, young individuals
most commonly in women.

 Most



may occur in

patients

do not have structura...
Atrioventricular nodal reentrant tachycardia.
heart rate 146 bpm with a normal axis.
Patient is in sinus rhythm following
atrioventricular nodal reentrant
tachycardia
 AV

nodal tissue is very important. In most
people, the AV node has a single conducting
pathway that conducts impulses i...
One pathway (alpha) is
a relatively slow
conducting pathway
with a short refractory
period,

the second pathway
(beta) is ...
Onset of AVNRT is triggered by a

premature atrial impulse.

A premature atrial impulse may reach the AV node
when the fas...
;the (beta) pathway continues to recover
because of its longer refractory period.
After the impulse conducts in an anterog...


Image A displays the slow pathway and the fast
pathway, with a regular impulse being
conducted through the atrioventric...
Image A displays
the slow pathway
and the fast
pathway, with a
regular impulse
being conducted
through the
atrioventricula...
AV REENTRANT
TACHYCARDIA
 AVRT

is the result of 2 or more conducting
pathways:
 the AV node and
 1 or more bypass tracts.
 In

a normal heart, only a single route of
conduction is present. Conduction begins at
the sinus node, progresses to the...


AVRT is associated with the Ebstein anomaly

 Accessory

pathways are errant strands of
myocardium that bridge the mit...
 The

accessory pathways may conduct
impulses in an




anterograde manner,
a retrograde manner,
or both.
When impulses travel down the
accessory pathway in an
anterograde manner,

ventricular preexcitation results.

This produc...
Wolff-Parkinson-White pattern. Note the
short PR interval and slurred upstroke
(delta wave) to the QRS complexe
 Concealed

accessory pathways are not
evident during sinus rhythm, and they are
only capable of retrograde conduction


A reentry circuit is most commonly
established by impulses traveling in an
anterograde manner through the AV node and
i...
A

reentry circuit may also be established by a
premature impulse traveling in an
anterograde manner through a manifest
a...


The left image displays the atrioventricular node
with the accessory pathway. The impulse is
conducted in an anterograd...
The left image displays the
atrioventricular node with
the accessory pathway. The
impulse is conducted in an
anterograde m...
Palpitation - Greater than 96%
Dizziness - 75%
Shortness of breath - 47%
Syncope - 20%
Chest pain - 35%
Fatigue - 23%
Diap...
distressed.

Tachycardia

tachypneic

hypotensive.

Crackles
secondary to
heart failure.

S3

large jugular
venous
pulsati...


Atrial Fibrillation



Ventricular Fibrillation



Atrial Flutter



Ventricular Tachycardia



Atrial Tachycardia
...









Electrocardiogram (ECG, EKG)—a test that records the
heart’s activity by measuring electrical currents throu...


ECG characteristics of the various SVTs are as follows:


Sinus tachycardia - Heart rate greater than 100 bpm; P
waves...


Multifocal atrial tachycardia - Heart rate 100-200 bpm; 3 or
more different P-wave morphologies



Atrial flutter- Atr...
Supraventricular tacchycardias
Supraventricular tacchycardias
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Supraventricular tacchycardias

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Supraventricular tacchycardias

  1. 1. Dr. Sunain Ashraf
  2. 2.  SVT any tachyarrhythmia that requires atrial and/or atrioventricular (AV) nodal tissue for its initiation and maintenance and narrow-complex tachycardia regular, rapid rhythm  exceptions atrial fibrillation (AF) multifocal atrial tachycardia(MAT)
  3. 3.  Depending on the site of origin of the dysrhythmia, SVTs may be classified as an atrial or AV tachyarrhythmia.
  4. 4. Atrial tachyarrhythmias • (1) sinus tachycardia • (2) inappropriate sinus tachycardia (IST) • (3) sinus nodal reentrant tachycardia (SNRT) • (4) atrial tachycardia • (5) multifocal atrial tachycardia • (6) atrial flutter • (7) atrial fibrillation..
  5. 5. AV tachyarrhythmias • (1) AV nodal reentrant tachycardia (AVNRT) • (2) AV reentrant tachycardia (AVRT) • (3)junctional ectopic tachycardia (JET) • (4) nonparoxysmal junctional tachycardia (NPJT).
  6. 6. AV Tachyarrhythmias
  7. 7.  most common cause of paroxysmal supraventricular tachycardia is AVNRT.  AVNRT is diagnosed in 50-60% of present with   regular narrow QRS tachyarrhythmia. The heart rate is 120-250 bpm quite regular
  8. 8.  AVNRT   healthy, young individuals most commonly in women.  Most   may occur in patients do not have structural heart disease. underlying heart condition rheumatic heart disease, pericarditis, myocardial infarction, mitral valve prolapse, or preexcitation syndrome.
  9. 9. Atrioventricular nodal reentrant tachycardia. heart rate 146 bpm with a normal axis.
  10. 10. Patient is in sinus rhythm following atrioventricular nodal reentrant tachycardia
  11. 11.  AV nodal tissue is very important. In most people, the AV node has a single conducting pathway that conducts impulses in an  anterograde manner to depolarize the bundle of His.
  12. 12. One pathway (alpha) is a relatively slow conducting pathway with a short refractory period, the second pathway (beta) is a rapid conducting pathway with a long refractory period. tachycardia.
  13. 13. Onset of AVNRT is triggered by a premature atrial impulse. A premature atrial impulse may reach the AV node when the fast pathway (beta) is still refractory from the previous impulse but the slow pathway (alpha) may be able to conduct. The premature impulse then conducts through the slow pathway (alpha) in an anterograde manner;
  14. 14. ;the (beta) pathway continues to recover because of its longer refractory period. After the impulse conducts in an anterograde manner through the slow (alpha) pathway, it may find the fast (beta) pathway recovered; the impulse then conducts in a retrograde manner via the fast (beta) pathway. If the slow pathway (alpha) has repolarized by the time the impulse completes the retrograde conduction, the impulse can then reenter the slow (alpha) pathway and initiate AVNRT
  15. 15.  Image A displays the slow pathway and the fast pathway, with a regular impulse being conducted through the atrioventricular node. Image B displays a premature impulse that is conducted in an anterograde manner through the slow pathway and in a retrograde manner through the fast pathway, as is seen in typical atrioventricular nodal tachycardia. Image C displays the premature impulse conducting in a retrograde manner through the pathway and the impulse reentering the pathway with anterograde conduction, which is seen commonly in patients with atypical atrioventricular nodal tachycardia.
  16. 16. Image A displays the slow pathway and the fast pathway, with a regular impulse being conducted through the atrioventricular node. Image B displays a premature impulse that is conducted in an anterograde manner through the slow pathway and in a retrograde manner through the fast pathway, as is seen in typical atrioventricular nodal tachycardia . Image C displays the premature impulse conducting in a retrograde manner through the pathway and the impulse reentering the pathway with anterograde conduction, which is seen commonly in patients with atypical atrioventricular nodal tachycardia
  17. 17. AV REENTRANT TACHYCARDIA
  18. 18.  AVRT is the result of 2 or more conducting pathways:  the AV node and  1 or more bypass tracts.
  19. 19.  In a normal heart, only a single route of conduction is present. Conduction begins at the sinus node, progresses to the AV node, and then to the bundle of His and the bundle branches.
  20. 20.  AVRT is associated with the Ebstein anomaly  Accessory pathways are errant strands of myocardium that bridge the mitral or tricuspid valves.  in AVRT, 1 or more accessory pathways connect the atria and the ventricles.
  21. 21.  The accessory pathways may conduct impulses in an    anterograde manner, a retrograde manner, or both.
  22. 22. When impulses travel down the accessory pathway in an anterograde manner, ventricular preexcitation results. This produces a short PR interval and a delta wave as is observed in persons with Wolff-ParkinsonWhite (WPW) syndrome
  23. 23. Wolff-Parkinson-White pattern. Note the short PR interval and slurred upstroke (delta wave) to the QRS complexe
  24. 24.  Concealed accessory pathways are not evident during sinus rhythm, and they are only capable of retrograde conduction
  25. 25.  A reentry circuit is most commonly established by impulses traveling in an anterograde manner through the AV node and in a retrograde manner through the accessory pathway; this is called orthodromic AVRT.
  26. 26. A reentry circuit may also be established by a premature impulse traveling in an anterograde manner through a manifest accessory pathway and in a retrograde manner through the AV node; this is called antidromic AVRT
  27. 27.  The left image displays the atrioventricular node with the accessory pathway. The impulse is conducted in an anterograde manner in the atrioventricular node and in a retrograde manner in the accessory pathway. This circuit is known as orthodromic atrioventricular reentrant tachycardia and can occur in patients with concealed accessory tracts or Wolff-Parkinson-White syndrome. The right image displays the impulse being conducted in an anterograde manner through the accessory pathway and in a retrograde manner via the atrioventricular node. This type of circuit is known as antidromic atrioventricular reentrant tachycardia and only occurs in patients with WolffParkinson-White syndrome. Both patterns may display retrograde P waves after the QRS complexes.
  28. 28. The left image displays the atrioventricular node with the accessory pathway. The impulse is conducted in an anterograde manner in the atrioventricular node and in a retrograde manner in the accessory pathway. This circuit is known as orthodromic atrioventricular reentrant tachycardia and can occur in patients with concealed accessory tracts or WolffParkinson-White syndrome. The right image displays the impulse being conducted in an anterograde manner through the accessory pathway and in a retrograde manner via the atrioventricular node. This type of circuit is known as antidromic atrioventricular reentrant tachycardia and only occurs in patients with Wolff-Parkinson-White syndrome. Both patterns may display retrograde P waves after the QRS complexes
  29. 29. Palpitation - Greater than 96% Dizziness - 75% Shortness of breath - 47% Syncope - 20% Chest pain - 35% Fatigue - 23% Diaphoresis - 17% Nausea - 13%
  30. 30. distressed. Tachycardia tachypneic hypotensive. Crackles secondary to heart failure. S3 large jugular venous pulsations
  31. 31.  Atrial Fibrillation  Ventricular Fibrillation  Atrial Flutter  Ventricular Tachycardia  Atrial Tachycardia  Atrioventricular Nodal Reentry Tachycardia (AVNRT)  Sinus Node Dysfunction
  32. 32.      Electrocardiogram (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heartmuscle Holter monitor or event monitor—an ambulatory monitor to record your heart rhythm that can be worn from 1-30 days to detect arrhythmias and correlate symptoms with the heart rhythm Exercise test—particularly if the symptoms occur during physical activity Electrophysiology study—an invasive test where monitoring wires are placed inside the heart and the heart's conduction system is tested directly Cardiac catheterization —a tube-like instrument inserted into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply
  33. 33.  ECG characteristics of the various SVTs are as follows:  Sinus tachycardia - Heart rate greater than 100 bpm; P waves similar to sinus rhythm  Inappropriate sinus tachycardia - Findings similar to sinus tachycardia; P waves similar to sinus rhythm  Sinus node reentrant tachycardia - P waves similar to sinus rhythm; abrupt onset and offset  Atrial tachycardia - Heart rate 120-250 bpm; P-wave morphology different from sinus rhythm; long RP interval (in general); AV block does not terminate tachycardia
  34. 34.  Multifocal atrial tachycardia - Heart rate 100-200 bpm; 3 or more different P-wave morphologies  Atrial flutter- Atrial rate of 200-300 bpm; flutter waves; AV conduction of 2:1 or 4:1  Atrial fibrillation - Irregularly irregular rhythm; lack of discernible P waves  AV nodal reentrant tachycardia - Heart rate of 150-200 bpm; P wave located either within the QRS complex or shortly after the QRS complex; short RP interval in typical AVNRT and long RP interval in atypical AVNRT  AV reentrant tachycardia - Heart rate of 150-250 bpm; narrow QRS complex in orthodromic conduction and wide QRS in antidromic conduction; diagnosis excluded by AV block during SVT; P wave after QRS complex
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