Paroxysmal Supraventricular Tachycardia Clinical Presentation

Updated: Apr 05, 2017
  • Author: Monika Gugneja, MD; Chief Editor: Mikhael F El-Chami, MD  more...
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Presentation

History and Physical Examination

History

Because symptom severity depends on the presence of structural heart disease and on the hemodynamic reserve of the patient, individuals with paroxysmal supraventricular tachycardia (paroxysmal SVT) may present with mild symptoms or severe cardiopulmonary complaints. Common presenting symptoms of paroxysmal SVT and their frequency rates are as follows [42, 48] :

  • Palpitations - Greater than 96%
  • Dizziness - 75%
  • Shortness of breath - 47%
  • Syncope - 20%
  • Chest pain - 35%
  • Fatigue - 23%
  • Diaphoresis - 17%
  • Nausea - 13%

Palpitations and dizziness are the most common symptoms reported by patients with SVT. Chest discomfort may be secondary to a rapid heart rate, and it frequently subsides with the termination of the tachycardia. Persistent SVT may lead to tachycardia-induced cardiomyopathy.

History should include time of onset, any triggers, any previous episodes or arrhythmia, and previous treatment. A detailed past medical and cardiac history and a complete list of all medications should be obtained.

Patients who are hemodynamically unstable should be resuscitated immediately with cardioversion. An electrocardiogram (ECG) should be performed as soon as possible.

Many patients with frequent episodes of paroxysmal supraventricular tachycardia tend to avoid activities such as exercising and driving due to past episodes of syncope or near-syncope.

Physical examination

Pertinent findings are generally limited to the patient’s cardiovascular and respiratory systems. Patients often appear quite distressed. Tachycardia may be the only finding in persons who are otherwise healthy and have significant hemodynamic reserve.

Patients who have limited hemodynamic reserve may be tachypneic and hypotensive. Crackles may be auscultated secondary to heart failure. An S3 may be present, and large jugular venous pulsations may also be visualized. [9, 48, 10]