An ER nurse is handling a 50-year-old woman complaining of dizziness and palpitations that occur from time to time. ECG confirms the diagnosis of paroxysmal supraventricular tachycardia. The client seems worried about it. Which of the following is an appropriate response of the nurse?
A. “You can be discharged now; this is a probable sign of anxiety.”
B. “The physician will prescribe you blood-thinning medications to lessen the episodes of palpitations.”
C. “We’ll need to keep you for further assessment; you may develop blood clots.”
D. "You have to stay here for a few hours to undergo blood tests to rule out myocardial infarction.”
Correct Answer: C. “We’ll need to keep you for further assessment; you may develop blood clots.”
Paroxysmal supraventricular tachycardia (PSVT) is characterized by episodes of rapid heart rate that occur periodically and stop on their own. PSVT decreases cardiac output and can result in a thrombus. These clots could turn into an embolus, which could eventually lead to a stroke. Treatment of PSVT in a patient is dependent on the type of rhythm present on the electrocardiogram and the patient’s hemodynamic stability.
Option A: The patient should not be discharged yet. A significant component of evaluation for a patient who presents with signs and symptoms of PSVT is history and physical exam. These should include vital signs (respiratory rate, blood pressure, temperature, and heart rate), a review of the patient’s medication list, and a 12-lead electrocardiogram.
Option B: Patients who are hemodynamically stable and have an electrocardiogram that shows a regular rhythm with undetectable P waves, Valsalva maneuvers, carotid sinus massage, or intravenous adenosine might be used to slow the ventricular rate or convert the rhythm into sinus rhythm and thus aid in the diagnosis. If intravenous adenosine does not work, then intravenous or oral calcium channel blockers or beta-blockers should be used.
Option D: The most common symptoms are dizziness and palpitations. Patients with PSVT and a known history of coronary artery disease may present with a myocardial infarction secondary to the stress on the heart. Patients with PSVT and a known history of heart failure may come in with acute exacerbation.
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