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Case Report

Beyond ACLS Protocol – A Rare Case of Refractory Supraventricular Tachycardia Responding Only to a Much Higher Dose of Adenosine

Sarat Kumar Naidu DNB Resident, Department of Emergency Medicine Max Hospital, Shalimar Bagh, New Delhi, Delhi 110088, India. , Sarat Kumar Naidu1 , Hilal Yatoo2 , Kishalay Datta3

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Indian Journal of Emergency Medicine 3(2):p 311-315, Jul-Dec 2017. | DOI: http://dx.doi.org/10.21088/ijem.2395.311X.3217.31

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Abstract

Symptomatic supraventricular tachycardia (SVT) is a common presentation in the Emergency Department which can be a lifethreatening condition and this requires immediate intervention. Stable SVTs are commonly treated with Adenosine but adenosine is more effective in AV nodedependant SVTs as it causes transient AV block [1] and causes normalization of the cardiac rhythm. American Heart Association AHA’s ACLS protocol recommends 6mg then 12mg (total 18mg) dose for SVTs [2]. However there is limited data as to how much maximum dose can be given for those SVTs that fail to terminate with standard dosing schedule [1]. This case report describes a 30 years old female with symptomatic SVT which failed to revert with normal dosing of adenosine neither with electrical cardioversion nor with multiple antiarrhythmic drugs but responded only to a much higher dose of adenosine.

Keywords: Supraventricular Tachycardia; AVRT (Atrioventricular ReEntry Tachycardia); AVNRT (Atrioventricular Reentrant Tachycardia); Adenosine; Cardioversion; ACLS (Advanced Cardiac Life Support); AV (Atrioventricular) Block; AHA (American Heart Association); ED (Emergency Department); Refractory; Ursodeoxycholic Acid; WPW Syndrome (Wolf Parkinson White). 

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.3217.31

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