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Periop SVT (Management strategy (Rate control (Advantages: Increased…
Periop SVT
Management strategy
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Rate control
Advantages: Increased diastolic filling time (increased SV - improved HD stability), also reduced CMRO2
Esmolol 500mcg/kg IV load over 1 min then 50mcg/kg/min IV (can be titrated fast, B1 selective - good for COPD but -ve inotrope effect so bad if severe LV dysfunction)
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Special groups
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WPW syndrome
Due to accessory conducting bundle between atria and ventricles, with no AV node to delay conduction - a depolarising wave therefore reaches the ventricle early and pre-excitation occurs
ECG changes (short PR interval, wide QRS with early slurred upstroke (delta wave))
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Avoid Adenosine, B blockers, CCBs, digoxin in AF - AV nodal blockers may promote conduction down accessory pathway - VF
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