Paroxysmal Supraventricular Tachycardia Case Study

Paroxysmal supraventricular tachycardia (PSVT) is a common condition in the emergency department which requires immediate intervention. PSVT may involve healthy individuals of all age groups but is much more common in patients with an underlying disorder including myocardial infarction, rheumatic heart disease, mitral valve prolapse, pericarditis, chronic lung disease, pneumonia, and alcohol or digoxin toxicity (1, 2). The prognosis of PSVT is dependent on the comorbid cardiac problems and is generally benign in patients with normal heart structure. Rarely, it could result in syncope, myocardial infarction, pulmonary edema, congestive heart failure and even sudden death. Moreover, it may result in secundum atrial septal defect in children of mothers who had PSVT in the second and third pregnancy trimesters (3).
CSM is routinely performed by applying pressure via longitudinal movements on the point of maximum impulse of the carotid artery which can be located just superior to the thyroid cartilage and inferior to the mandible angle. However, the physician has too perform this maneuver with a blind fashion and the location of carotid body may differ between individuals based on their anatomic variations (5). As a result, the efficacy of this maneuver is usually very low and it may fail in up to 90% of cases