 What is the diagnosis?
This is a narrow complex regular tachycardia. The differential diagnosis includes - sinus tachycardia, atrial flutter, paroxysmal supraventricular tachycardia PSVT which includes AVNRT - AV nodal reentrant tachycardia and AVRT (Atrioventricular Reciprocating Tachycardia), atrial tachycardia, irregular narrow complex tachycardias would include MAT (Multifocal Atrial Tachycardia) and Atrial Fibrillation. The most commonly seen etiology is PSVT. There do not appear to be P waves. However it is difficult to definitively rule out the other etiologies. One must always consider Atrial Flutter with 2:1 block when the HR is around 150. Best lead to see P wave activity is V1 (here red arrows show some blips which may be buried Ps) Is there a role for adenosine?
Adenosine will frequently terminate a PSVT and unmask underlying atrial flutter so can often be diagnostic Name an initial non-pharmacologic intervention
Vagal maneuvers. Consider using a 10 cc syringe and asking the patient to blow the plunger out ( Lin ALiEM 2012 ). Additionally there may be improved success with vagal maneuvers using postural modification as described in the REVERT Trial ( Wiki EM Summary ) Take Home Points
1. Always consider Atrial Flutter with 2:1 conduction if the HR is around 150s
2. Adenosine can be therapeutic (terminating PSVT) and and diagnostic (unmasking P waves) 3. Consider postural modification to vagal maneuvers Resources: Lin,Michelle (2012,June26) https://www.aliem.com/2012/06/tricks-of-trade-valsalva-maneuver-by/ Brady WJ, Laughrey TS, Ghaemmaghami CA. Cardiac Rhythm Disturbances. In: Tintinalli JE, Stapcyznski JS, Ma OJ, Yealy DM, Meckler CD, Cline DM, editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 8th ed. McGraw-Hill; 2011. Appelboam A. et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet 2015 Oct 31;386(10005):1747-53
9 Comments
Stephanie Sally
6/9/2025 07:12:53 am
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6/29/2025 01:35:00 am
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Charles Coffey
11/7/2025 01:42:54 am
LOTTERY WINNER: I’ve always believed in doing good and standing up for what’s right, but something truly extraordinary happened to me thanks to Lord Bubuza. For years, I faithfully played Lotto Max, hoping my luck would change one day. No matter how many tickets I bought, winning always seemed just out of reach. Then, while reading amazing success stories online, I came across Lord Bubuza. Feeling inspired, I decided to reach out to him. He listened to my story, performed a special lottery spell, and shared specific numbers for me to play. To my absolute shock and joy, those numbers turned out to be the winning combination! I won $1,000,000, and my life has completely changed since that moment. I’ll forever be grateful to Lord Bubuza for his guidance, kindness, and powerful spiritual help. If you’ve lost hope or need a miracle, don’t give up. Contact Lord Bubuza via email: [email protected] or WhatsApp: +1 (365) 808 5313 and see what wonders await you CONTACT Mr William adams call +2349120287787or WhatsApp him through this number +2349120287787or email: [email protected] everyone My name is William adams am from California i am here to give a testimony on how I join the illuminati brotherhood, I was trying to join this organization for so many years now,I was scammed by fake agent in south Africa and Nigeria,I was down,I could not feed my self and my family anymore and I tried to make money by all miss but all invail, I was afraid to contact any illuminati agent because they have eat my money,One day I come across a post of someone giving a testimony, thanking a man called William adams of being helping him to join the illuminati brotherhood, then I look at the man email and the phone number that was written there, it was a nigeria number I was afraid to contact him because a nigerian agent eat my $6000 and go away with the money then I was very tired, confused and I decided to contact the person that was given the testimony and i called him and I communicated with him on phone calls before he started telling me his own story about when he wanted to join, he told me everything to do, then I made up my mind and called the agent called Steve Marco and he told me everything to do, and I was initiated, surprisely I was given my benefit of being a new member of the great illuminati brotherhood I was so happy, For those of you trying to join this organization this is your opportunity for you to join CONTACT MR William adams call +2349120287787or WhatsApp him +2349120287787or email: [email protected]
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11/27/2025 06:46:03 pm
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Manuel
12/1/2025 03:50:44 am
I promised Great Dr. Odunga to post this testimony and I really want to say "Thank You" to everyone who supported me through the years. My name is Manuel Franco, New Berlin, Wisconsin. My story of how I won the Powerball lottery of $768.4M is a bit of a tale. I was feeling very lucky that day because I had contacted Great Odunga to help me with the winning Powerball numbers. I really had that great great feeling that I looked at the camera wanting to wink at it. I only did a tiny part of it when he told me he would give me the numbers and trusted him. He gave me the numbers after I played a couple other tickets along with it for $10. I checked my ticket after the winnings came online and saw the numbers were correct including the Power play. I screamed for about 10 minutes because it felt like a dream coming into reality. I had won $768.4M. Thank you Great Odunga. Well, his email is [email protected] You can also call or Whats-app him at +2348167159012 so you guys can contact him
Davidhatt
12/13/2025 03:32:07 am
I still can’t believe how my life has changed. I'm David Hatt from Kingston, Ontario. I went from struggling to keep up with bills to becoming one of the largest lottery winners the city has ever seen. meeting Chief Ade was a turning point in my life, and I know my journey will inspire a lot of people. Chief Ade’s guidance gave me hope when I needed it most, and that hope turned into the opportunity of a lifetime for me. I'm overwhelmed with gratitude, grateful for the blessing, grateful for the support, and grateful for making me believe it was possible ( Chief Ade ). Today I'm living a life I once only dreamed of, and I will never stops giving thanks to Chief Ade for making me one of the largest lotto max jackpot in Canadian history, I hope my story gives anyone who is trying to win the lottery faith that miracles really can happen with the help of Chief Ade Spell, Email: [email protected] or WhatsApp +234 901 380 6328 Leave a Reply. |
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