PSVT

A 75 years old female came to JIPMER hospital, Pondicherry, India with chief complaints of acute onset palpitation on and off since last one hours along with atypical chest pain and giddiness. Patient was a known case of Hypertension and diabetes mellitus since last 15 years for which she was on oral medication. Patient was also giving history of similar palpitation one week back. During evaluation in the emergency patient pulse was 190 beats per minute, BP-110/70  mmhg, ECHO was suggestive of concentric LVH, there was no regional wall motion abnormality. Patient ecg done in the emergency department is shown below.

Tachycardia ECG

ECG is suggestive of narrow QRS complex tachycardia, regular in rhythm, rate around 190 beats per minute, there were no clearly visible P wave, most likely P wave merged into the QRS complex, no significant ST-T wave changes were seen. Because P wave merged into the QRS complex so the RP interval is less than 70 msec.  So the ecg is suggestive of Short RP tachycardia with differential diagnosis being AVNRT (Atrioventricular nodal reentry tachycardia), AVRT (Atrioventricular reentry tachycardia)or rarely possibility of Atrial tachycardia(AT)

Another tachycardia ECG

Patient was given carotid sinus massage, but she did not improved so injection adenosine 6 mg was given via antecubital vein. Tachycardia subsided within few minutes. ECG after tachycardia subsided is shown below.

ECG is showing normal sinus rhythm at 66 beats per minute, PR interval 140 msec, normal axis, no ST-T wave changes seen.

So final diagnosis of the patient was PSVT with Differential diagnosis being AVNRT, AVRT, Atrial tachycardia.


Let discuss how to approach in a patient with PSVT

Thank you.

Praveen Gupta