What is a common initial treatment for stable PSVT?

What is a common initial treatment for stable PSVT?

• A. Immediate defibrillation
• B. Vagal maneuvers
• C. Intravenous lidocaine
• D. Beta-blocker infusion only

Answer: (B)

When a patient with PSVT is stable, the aim is to interrupt the reentrant circuit by slowing conduction through the AV node. The most common initial approach is vagal maneuvers, which boost parasympathetic activity and increase the AV node’s refractory period. A quick Valsalva maneuver (bearing down, like during a bowel movement) or, when appropriate, carotid sinus massage can terminate the tachycardia by slowing AV nodal conduction long enough to break the circuit. If successful, normal rhythm returns without medication or procedures. If vagal maneuvers don’t work, the next steps typically involve pharmacologic attempts such as adenosine, which transiently blocks AV nodal conduction to terminate the tachycardia or reveal the underlying rhythm. Beta-blockers or calcium channel blockers can be used for rate control in some stable patients, and electrical cardioversion is reserved for those who become unstable. Immediate defibrillation isn’t used in stable PSVT because there is adequate pulse and hemodynamic stability, making noninvasive vagal maneuvers a safer first option. Intravenous lidocaine targets ventricular arrhythmias rather than PSVT.

When a patient with PSVT is stable, the aim is to interrupt the reentrant circuit by slowing conduction through the AV node. The most common initial approach is vagal maneuvers, which boost parasympathetic activity and increase the AV node’s refractory period. A quick Valsalva maneuver (bearing down, like during a bowel movement) or, when appropriate, carotid sinus massage can terminate the tachycardia by slowing AV nodal conduction long enough to break the circuit. If successful, normal rhythm returns without medication or procedures.

If vagal maneuvers don’t work, the next steps typically involve pharmacologic attempts such as adenosine, which transiently blocks AV nodal conduction to terminate the tachycardia or reveal the underlying rhythm. Beta-blockers or calcium channel blockers can be used for rate control in some stable patients, and electrical cardioversion is reserved for those who become unstable.

Immediate defibrillation isn’t used in stable PSVT because there is adequate pulse and hemodynamic stability, making noninvasive vagal maneuvers a safer first option. Intravenous lidocaine targets ventricular arrhythmias rather than PSVT.