Evaluation and Initial Treatment of Supraventricular Tachycardia

Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage A 24-year-old woman presents to the emergency department with the sole symptom of ?a racing heart,? which began abruptly while she was eating dinner. She reports having had prior episodes of palpitations that resolved spontaneously. In the emergency room, her blood pressure is 84/60 mm Hg. An electrocardiogram (ECG) reveals a regular narrow-complex tachycardia at a rate of 190 beats per minute without clear atrial activity (P waves). How should this case be managed? The Clinical Problem Patients with symptomatic tachycardias require immediate medical attention. Although it is commonly believed that a precise diagnosis of the tachycardia . . .