A 54-year-old lady presented with reeling of head for one day. She has history of syncope yesterday. She gives similar history in the past. She was sitting comfortably. Her pulse was not palpable. BP not recordable. Her heart rate was around 200 beats per minute on auscultation. Chest was clear. Diagnosis and management.

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whenever absent pulse. .BP not recordable. syncope also..but .pt is able to walk normally think of pulseless disease. .takayasus arteritis. .look for all 4 limbs pulse and arterial bruit

Very nice
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SVT. PT IS UNSTABLE. .give 100 joules DC cardioversion.. IV LINE.OXYGEN. TO B GIVEN. Once reverted then check the vitals if normal then start verapamil or beta blocker. Sr. electrolytes. echo .EPS Study. to b done. .thyroid profile also

What happens when we give Verapamil in unstable case. what we can do in periphery
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PSVT . inj adenosine 6mg bolus(then 12+12mg aliquots) or inj diltiazem 0.25mg /kg iv can be given,if hemodynamically stable.then start oral tablets.but if unstable can directly go for synchronised cardioversion , after sedation if patient conscious.

Paroxysmal Supraventricular Tachycardia. Try unilateral carotid massage first. If no response, Inj Diltiazem 10 mg to 15 mg stat IV stat repeat if required. Put on Tab Dilzem SR 90 mg 1 OD. Can add Beta blocker as an add-on. Alternatively Inj Adenosine 6 to 12 mg stat IV bolus. DC shock in resistant case starting with 150 J and increased if needed. Also, do serum electrolytes and 2 D ECHO and also hyperthyroidism. Arrhythmia mapping, Ablation if aberrant tract is defined. Educate the patient about manoeuvre of unilateral Carotid massage as a primary measure in case he develops it again.

I gave unilateral carotid massage and also asked her to take ice cold water.
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Here it's not takayasu.dr suResh just sharing his approach ........

Yes sir. Thanks sir
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SVT or PSVT several cases treated in past mostly by inj Adenosine

in increasing doses with other supporting treatment,but success rate of adenosine only 50 %,followed by verapamil or beta blocker.There is no mortality even some cases remain without conversation even for 48 hrs.After stable with sinus rhythm, sent them for electrophysiological study nearby.Many of them then undergone for ablation for aberrant bundle followed by stoppage of drugs.
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PSVT since BP was not recordable Sync cardioversion is first line of Rx. Evaluate for precipitating cause. start on beta blockers or Verapamil send for electrophysiology and ablation of aberrant pathway

Its SVT.PL give iv diltiazem/ metaprolol/ verapamil in this order if no response in that sequence. Pl get 2d echo & EP Study

In this patient,if pulse not palpable and BP not recordable ,DC shock straightaway instead of pharmacotherapy as first choice.

I agree with u sir. that is as per ACLS protocol
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Just today had 28 yr male pulse 230 BP 60 pt stable ECg classical AVNRT OR AVRT adenosine worked

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