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Old 06-22-2011
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EKG Arrhythmia converted to sinus rhythm by Adenosine

A 50 year old woman is brought to the emergency room with palpitations and dizziness. She has a history of arrhythmia. Adenosine is given and the patient converts to sinus rhythm. With which of the following rhythms did this patient most likely present to the ER?

A. Ventricular Tachycardia
B. Atrial fibrilation
C. Atrial Flutter
D. Paroxysmal supraventricular tachycardia
E. Ventricular fibrilation
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D. Paroxysmal supraventricular tachycardia.

In fact it's the only disease that Receives "Adenosine" No where else Adenosine is used except in Supraventricular Tachycardia.
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Old 06-22-2011
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Yes. SVT!

Intravenous Adenocard (adenosine injection) is indicated for the following.
Conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome). When clinically advisable, appropriate vagal maneuvers (e.g., Valsalva maneuver), should be attempted prior to Adenocard administration.


Adenocard does not convert atrial flutter, atrial fibrillation, or ventricular tachycardia to normal sinus rhythm. In the presence of atrial flutter or atrial fibrillation, a transient modest slowing of ventricular response may occur immediately following Adenocard administration.
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Answer D. SVT
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D. Paroxysmal supraventricular tachycardia
DOC is adenosine the clue for dx
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D. Paroxysmal supraventricular tachycardia
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Default D!

D - paroxysmal supraventricular tachycardia
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Indeed is Paroxysmal supraventricular tachycardia
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Answer is (choice D: PSVT)
Adenosine is the drug of choice in SVT by blocking the accessory pathway or re-entrant pathway --> end of re-entry --> stop of SVT very fast

Adenosine is not effective in converting rhythms other than PSVT, such as atrial flutter, atrial fibrillation, or ventricular tachycardia, to normal sinus rhythm. To date, such patients have not had adverse consequences following administration of Adenosine.

Clinical Trial Results
In controlled studies in the United States, bolus doses of 3, 6, 9, and 12 mg were studied. A cumulative 60% of patients with paroxysmal supraventricular tachycardia had converted to normal sinus rhythm within one minute after an intravenous bolus dose of 6 mg Adenosine (some converted on 3 mg and failures were given 6 mg), and a cumulative 92% converted after a bolus dose of 12 mg. Seven to sixteen percent of patients converted after 1 to 4 placebo bolus injections.* Similar responses were seen in a variety of patient subsets, including those using or not using digoxin, those with Wolff-Parkinson-White Syndrome, males, females, blacks, Caucasians, and Hispanics.
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Old 06-23-2011
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While I'm not certain how commonly vagal maneuvers are used in the real clinical world, the Step 2 practice questions I encountered always insisted that vagal maneuvers* should be tried first.
If no results, then use adenosine. Verapamil can be used if adenosine is not effective. Metoprolol can be used to decrease the rate.

*Vagal maneuvers include: carotid sinus massage, Valsalva (bearing down or forcefully exhaling against a closed mouth and nose), face in cold water, holding breath, and coughing, and rectal stimulation. Vagal maneuvers increase vagal tone and decrease conduction through AV node. They can be useful in pts with supraventricular tachycardia or atrial fibrillation.

Be sure to check for carotid bruits since carotid massage is CONTRAINDICATED in bilateral carotid stenosis.

I also found the following link to be helpful: http://www.adaweb.net/Portals/0/Para...cuments/1q.pdf

According to MTB Step 3, in SVT:

Best initial management for unstable patients: synchronized cardioversion
Best initial management for stable patients: vagal maneuvers
Next best step in management if vagal maneuvers do not work: IV adenosine
Best long-term management: radiofrequency catheter ablation
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