P007: A CASE OF POST-OPERATIVE SUPRAVENTRICULAR TACHYCARDIA (SVT): IDENTIFICATION, PATHOPHYSIOLOGY, AND MANAGEMENT IN THE PACU SETTING
Gordon J Hubbell, DO; Kylie Schmitt, DO
HCA Florida Westside/Northwest Anesthesia
Introduction/Background: Diagnosis and management of cardiac arrhythmias are a crucial aspect of ACLS, and knowing how to treat these life-threatening conditions is an important responsibility we have as health care providers. Tachyarrhythmias are defined as abnormal ventricular heart rhythms with a ventricular rate of 100 bpm or more, and they have a variety of causes and symptoms. SVT is a broad term which includes several different variations, generally it is defined as a dysrhythmia originating at or above the atrioventricular (AV) node, above the ventricular conducting system (purkinje fibers) with a narrow complex (QRS < 120 milliseconds) at a rate of 100 or more bpm. Included in this group are Afib, Aflutter, paroxysmal SVT, and WPW syndrome. The cause of these electrical abnormalities is generally due to re-entry or automaticity in the cardiac conduction system.
Methods/Case Report: The patient in this case was a 64 year old female who underwent a total vaginal hysterectomy under general anesthesia for uterine fibroids. Her BMI was 24, home meds included levothyroxine (taken day of surgery) and metoprolol. Her PMHX included hypothyroidism, HTN, uterine fibroids, palpitations, and HLD and her PSHx included a bilateral breast augmentation. Preop vitals within normal limits with a HR of 67 bpm. She received general anesthesia with ETT and intra-op there were no significant complications. The patients HR remained between 65-95 range throughout the case. Post-op she reported her pain was well controlled, VSS with a HR of 70 bpm. After 15 minutes being recovered in PACU, however, the patient experienced a new onset episode of SVT with symptomatic dyspnea and palpitations with a HR of 160 sustained with no known inciting event. BPs measured were stable, 100s/60s, and O2 sat remained 100% on room air. Initially vagal maneuvers were utilized, including valsalva and carotid massage, which slowed the HR only temporarily. 50 mg of esmolol was then used with minimal effect. 6 mg of adenosine was finally used with a successful termination of the tachyarrhythmia and resolution of the patients symptoms. After the event, the patient reported she had forgot to mention she had these palpitations in the past for which she follows up with a cardiologist, and had remembered the feeling of receiving adenosine stating she had been given it before. Her cardiologist was notified and the patient improved through the rest of her recovery.
Results: The incidence of AVNRT is 2.29/1000 persons and is the most common non-sinus tachydysrhythmia in young adults. Women have 2X higher risk of developing paroxysmal SVT in comparison to men, and older individuals have 5X higher compared to a younger person. SVT is the most common symptomatic dysrhythmia in infants in children.
Discussion/Conclusion: The purpose of this case report is to discuss the recognition, diagnosis, cardiac pathophysiology, and indications/treatment methods for SVT using this unique case as an example. The step-by-step differential diagnosis, planning, and treatment methods used in this case led to a positive outcome which successfully treated this patients SVT.