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Palpitations 

Palpitations
Chapter:
Palpitations
Source:
Acute Care Casebook
Author(s):

Colin Turner

DOI:
10.1093/med/9780190865412.003.0042

This case deals with the recognition and management of atrioventricular nodal re-entrant tachycardia (AVNRT), the most common narrow-complex tachyarrhythmia. The differential diagnosis of narrow-complex tachycardia is considered, with suggestions to aid in electrocardiographic and clinical distinction of various arrhythmias. Nonpharmacologic management strategies are outlined, including an emphasis on the Valsalva maneuver with postural modification, as recently examined in the REVERT trial. Finally, pharmacologic management is discussed, including the use of adenosine. Key management points include recognition of the differential diagnosis for regular, narrow-complex tachycardia, attempting nonpharmacologic maneuvers to terminate AVNRT, and, if necessary, administering adenosine as the first-line pharmacologic step.

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