when do you admit patient with SVT

[Painter1]

young girl in her 20s, no past med hx other than episodes of palpitations that have self-resolved in the past. presents with palpitations. ekg with svt, converts with vasalva manuever. no symptoms now. do you send her home? do you do labs?

no family hx of sudden death, no wpw on ekg.

what r u indications for admission? would u even do labs in the ed if you can arrange f/u with EPS?

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[WilcoWorld]

I check a chemistry, though I can't say that I have good evidence for this, and if it's a young female I check a pregnancy as well.

If it's just SVT, and I get it converted, then I never admit. If I'm admitting SVT it's because I found something else.

 

[crewmaster1]

I always check thyroid studies on these patients as well. Utox also crosses my mind. New-onset SVT with symptoms gets admitted, asymptomatic (other than palpitations or some BS symptom) can go home if they have good follow-up(rarely-so most get admitted). Probably on a calcium channel blocker if cards wants it. They workup really needs an echo for structural disease.

 

[J-Rad]

...The[ir] workup really needs an echo for structural disease.

If they are otherwise asymptomatic with a normal EKG a young person with a negative PMH probably doesn't need an echo to rule out structural heart disease.

 

[Janders]

I think you should look at it the other way... who needs to stay after an episode of SVT? I just made this list off my head:

(1) Older people with know CAD or structural heart disease
(2) Syncope, or symptoms severe enough that you electrically cardioverted them.
(3) Murmur or history c/w IHSS or other young-person structural disease
(4) WPW EKG (though I have sent them home with cards f/u within a few days)
(5) People who didn't convert with vagal/adenosine... if I am hanging a fancy drug, they probably get to stay
(6) Other suggestions?

90% of random young people go home.

 

[EctopicFetus]

Just saw a lady almost 80 with SVT that maxed out at 205 (fastest I have ever seen in someone this old). I converted her, called her cards doc and discharged her home.

Janders list looks good.

I would also add someone with increased frequency of SVT, if someone has it once every 3 years and now had their 3rd episode in 2 weeks I will admit for cards eval.

Also I check a EKG after conversion and a chemistry to look for a possibly reversible cause.