MDM:
Diagnosis: Supraventricular tachycardia, stable
Evaluated patient for stability and suspect H and stable given:
No respiratory distress.
No chest pain that is suspected to be ischemic.
Mentating well with no evidence of encephalopathy on exam.
Maintaining sufficient blood pressure.
- Give instability, will elect for pharmacologic conversion of supraventricular tachycardia. Pads on pt in case of hemodynamic deterioration
- Adenosine 6 mg IV push with flush afterwards administered.
- Refractory to initial adenosine
- Adenosine 12 mg IV flush with flush afterwards administered.
- Normal heart rate.
- Repeat EKG obtained.
- On repeat EKG:
- EKG: Normal Sinus Rhythm. No arrythmia (no PACs, no PVCs), no brugada wave, no prolonged QTc, no delta wave/no shortened PR, no episilon wave, no evidence of ischemia. Interpretation: No cardiogenic etiology for arrhythmia obvious on EKG.
Diagnostically:
Will evaluate for underlying precipitance that may have caused arrhythmia as above.
CBC to evaluate for significant anemia
BMP and Magnesium and phosphorus to evaluate for electrolyte abnormalities.
Chest x-ray
Urinalysis
Utox
to evaluate for occult infections that were not elucidated on review of systems or examination.
Evaluate for myocardial ischemia resulting from episode of arrhythmia.
Troponin
Therapeutically:
Will administer rate control to prevent subsequent episode.
Cardiology consulted.