Atrioventricular Nodal Reentry Tachycardia Clinical Presentation

Updated: Nov 19, 2019
  • Author: Brian Olshansky, MD, FESC, FAHA, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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Presentation

History

Atrioventricular nodal reentry tachycardia (AVNRT) is typically characterized by an abrupt onset and termination. Episodes may last from seconds to minutes to days. In the absence of structural heart disease, it is usually well tolerated.

Common symptoms include the following:

  • Palpitations

  • Nervousness

  • Anxiety

  • Lightheadedness

  • Neck pounding [6]

  • Neck and chest discomfort

  • Dyspnea

  • Polyuria - Can occur after termination of an episode (due to the release of atrial natriuretic factor)

AVNRT may cause angina or myocardial infarction in patients with coronary artery disease and may cause or worsen heart failure in patients with poor left ventricular function.

Syncope may occur in patients with a rapid ventricular rate or prolonged tachycardia due to poor ventricular filling, decreased cardiac output, hypotension, and reduced cerebral perfusion. Syncope may also occur because of transient asystole when the tachycardia terminates, due to tachycardia-induced depression of the sinus node.

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Physical Examination

The heart rate is usually rapid, ranging from 150-250 beats per minute (bpm). It is usually 180-200 bpm in adults; in children, the rate may exceed 250 bpm.

Cannon A waves can be seen in the neck due to simultaneous atrial and ventricular contraction.

Hypotension may occur initially or with rapid ventricular rates and prolonged episodes. Sometimes, initial hypotension evokes a sympathetic response that increases blood pressure and may terminate the tachycardia by an increase in vagal tone.

Rarely, signs of left heart failure may develop or worsen in patients with poor left ventricular function.

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