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Wed Jan 3 19:24:11 GMT 2007

Pret,

  I know that SVT isnt a compensatory mechanism, but I guess Im confused to have an MD tell me that nitro caused her SVT....I had never heard of such a thing, and then started to reach for explainations, nitro vasodialates, I would expect a slight rise in HR, but SVT? i was thrown off. She converted nicely to a sinus rhythm, but stayed hypotensive.

"Bjorn, Pret" <pbjorn at emh.org> wrote:
  NYG? The New York Giants are causing SVT?

You're right: this ain't trauma. Maybe we can answer it quick and get outta here.

First, without an ECG to look at -- probably even WITH one -- you have to wonder about the working diagnosis. SVT is an uncommon declaration given a rate that low (even prorating for age). Tell me about her p-waves. And it'd be interesting to know what her heart rate was when you met her, and after the adenosine "converted" her.

But trusting this conclusion nonetheless, I'm sure you understand that SVT is not a compensatory response to anything. It's an irritability and/or aberrant conduction phenomenon, which may have been touched off by the effects of the nitro, or her endogenous catecholamines, or bad luck (odds increasing from the former to the latter). 

In the end, though, it doesn't really matter. You can't take much useful from this case; all you can do is become more hesitant to give nitrates to patients with chest pain. Depending on your knowledge and experience level, this may be a good or bad effect.

Back to trauma, then. Hope this helps a bit.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of David Sullivan
Sent: Tuesday, January 02, 2007 5:09 PM
To: Trauma & Critical Care mailing list
Subject: NYG induced SVT

Hello All, 

I know that this list is more trauma based education, and cases, but I came across a "routine" medical call and got a strange answer from the MD that accepted my pt. here it is 

82 yoF from Nursing home, pt c/o 6/10 c/px 30mins, staff admin 1 NTG tab, and her pressure droped to 80/40 the called EMS, we found her in bed CAOx4, still c/o of the chest pain, her vitals where 140, 90/60, 22, l/s CTAB. bs 184mg/dl pt was moved to the ambo where there was no acute change, IV, o2, monitor, and 12 lead EKG done, along with a right sided 12-lead too 162mg asprin PO. her rate didnt change and bounced back between high 130s and mid 140s.

while I was finishing my trip sheet, the MD told me that she broke her SVT w/ adenosine, and that she was doing better. I asked her why, and she told me that NTG can induce SVT, I understand why pts become tachacardic as a compensatory mechanism for the vasodialation, but the NTG must have worn off within 10 min transport. I was very confused, any help would be appreciated 

dave sullivan BA NREMT-P
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NYG induced SVT