Emergency Medical Minute4 Syys 2024

Episode 919: EKG Criteria for Adenosine

Contributor: Travis Barlock, MD

Educational Pearls:

SVT: supraventricular tachycardia

Pharmacotherapy for SVT includes drugs that block the AV node, such as adenosine

EKG criteria before adenosine administration in SVT

Regular rhythm
Monomorphic: all QRS complexes are identical

If the EKG is polymorphic, with QRS complexes displaying changing morphologies, it is unsafe to administer adenosine

Adenosine can worsen polymorphic VTach and lead to VFib

References

Ganz, Leonard I., and Peter L. Friedman. "Supraventricular Tachycardia." New England Journal of Medicine, vol. 332, no. 3, 19 Jan. 1995, pp. 162–173, https://doi.org/10.1056/nejm199501193320307.
Smith JR, Goldberger JJ, Kadish AH. Adenosine induced polymorphic ventricular tachycardia in adults without structural heart disease. Pacing Clin Electrophysiol. 1997;20(3 Pt 1):743-745. doi:10.1111/j.1540-8159.1997.tb03897.x
Viskin, Sami, et al. "Polymorphic Ventricular Tachycardia: Terminology, Mechanism, Diagnosis, and Emergency Therapy." Circulation, vol. 144, no. 10, 7 Sept. 2021, pp. 823–839, https://doi.org/10.1161/circulationaha.121.055783.

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3

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