The present case is focused on the treatment of supraventricular tachycardia (SVT) in an adolescent patient. The patient reports chest pain and presents with high blood pressure, elevated heart rate, and left ventricular enlargement with pulmonary engorgement. Pharmacological treatment of the condition is required to manage the condition and relieve the symptoms associated with it. The paper will aim to discuss pharmacologic management recommendations based on the patient’s symptoms and medical history.
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Pharmacologic Management of SVT
When considering the options for pharmacological therapy of STV in pediatric patients, it is critical to consider factors such as the child’s age, symptoms, and the history of the condition. In the present case, STV has been diagnosed before, which is why it is essential to treat the current episode as well as prevent future recurrences. The main pharmacological treatment used for acute termination of STV is adenosine. The use of adenosine in acute cases of STV is supported by the 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients with Supraventricular Tachycardia, which also discusses the treatment of STV in children and adolescent (Page et al., 2015). Studies of successful SVT treatment in pediatric settings also report on the successful use of adenosine.
For instance, Díaz-Parra et al. (2014) found that adenosine therapy had a 75% effectiveness when managing episodes of SVT. The recommended dose and the number of doses required to treat SVT depend on patient’s weight and the severity of symptoms. Page et al. (2015) state that “Higher initial doses of adenosine are needed in children than in adults, with children receiving from 150 mcg/kg to 250 mcg/kg” (p. 190). Similarly, Díaz-Parra et al. (2014) report that the mean effective dose of adenosine for SVT is 173 mcg/kg, and the mean number of doses required for reverting the SVT to normal sinus rhythm is 1.7. Given the previous history of the disease and the current symptoms, the key recommendation for pharmacologic management of SVT in the patient would be to administer 200 mcg/kg and repeat the dose if the symptoms persist after 12-24 hours.
Management of Elevated Blood Pressure
High blood pressure also requires pharmacological treatment, as it affects the condition of the heart in the long-term. Given the patient’s blood pressure values, pharmacological treatment is needed for managing elevated blood pressure. Beta-blockers are often used to treat blood pressure in adults, and they are also suitable for adolescents. According to the 2016 European Society of Hypertension Guidelines for the Management of High Blood Pressure in Children and Adolescents, beta blockers can be used in combination with diuretics or on their own, depending on the severity of hypertension (Lurbe et al., 2016). Beta-blockers will also have a beneficial effect on SVT. As noted by Escudero, Carr, and Santani (2013), beta-blockers can have a 50 to 90% effectiveness in preventing the recurrences of SVT episodes. Given the patient’s readings, it would be best to start with a low dose of beta-blockers, such as Atenolol or Metoprolol at 1 mg/kg daily, combined with a diuretic, such as furosemide at 0.5 mg/kg twice daily (Lurbe et al., 2016). Monitoring of blood pressure and heart rate during follow-up visits will also be necessary to track the patient’s progress and the effectiveness of prescribed treatment.
Chest pain may be a symptom associated with high blood pressure, in which case the prescribed treatment would be effective in relieving it. However, it may also indicate a more serious problem, such as heart failure, and thus further evaluation is required. First of all, it is critical to find out more about the symptom, including information about onset, connections to physical activity or food intake, and the severity of chest pain. Then, it would be useful to conduct further diagnostic testing after the acute SVT episode is treated. The first diagnostic testing required is transthoracic echocardiography aimed at confirming or ruling out other cardiovascular diseases, including congenital heart disease and heart failure (Kantor et al., 2013). Moreover, it would be useful to perform laboratory tests, including “Assessment of electrolytes (Naþ, Kþ, Cl, Ca2þ), glucose, acid-base status, urea and creatinine, hepatic transaminases, thyroid hormone levels, and a complete blood count” (Kantor et al., 2013). Collecting the results of all the diagnostic tests listed would assist in obtaining a clear picture of the patient’s heart condition and establishing the cause of chest pain so that an appropriate treatment option could be selected.
Heart failure in adolescents is not a common problem, but it might develop in connection with other heart conditions, including SVT and hypertension, which are evident in the patient. Kantor et al. (2013) state that in adolescents, heart failure is usually associated with fatigue, effort intolerance, dyspnea, orthopnea, abdominal pain, nausea, and vomiting, while palpitations and chest pain are rarely observed in this age group. The patient’s blood pressure, chest X-Ray, and heart rate are consistent with hypertension, which should be considered as the most probable diagnosis. Therefore, based on the information provided in the case, the patient does not meet the criteria for heart failure in adolescents, and no pharmacological treatment for heart failure should be considered at the moment. However, further testing ordered in relation to chest pain will assist in ruling out heart failure completely.
Overall, the patient’s condition can be managed successfully using the treatment discussed in the paper. Adenosine therapy will help in terminating the current STV episode, while beta-blockers combined with diuretics will assist in reducing blood pressure to normal values and preventing SVT recurrences. Nevertheless, further diagnostics and careful monitoring of blood pressure, heart rate, and ECG will be required to confirm the effectiveness of the chosen treatment and make alterations if necessary.
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Díaz-Parra, S., Sánchez-Yañez, P., Zabala-Argüelles, I., Picazo-Angelin, B., Conejo-Muñoz, L., Cuenca-Peiró, V.,… García-Soler, P. (2014). Use of adenosine in the treatment of supraventricular tachycardia in a pediatric emergency department. Pediatric Emergency Care, 30(6), 388-393.
Escudero, C., Carr, R., & Sanatani, S. (2013). Overview of antiarrhythmic drug therapy for supraventricular tachycardia in children. Progress in Pediatric Cardiology, 35(1), 55-63.
Kantor, P. F., Lougheed, J., Dancea, A., McGillion, M., Barbosa, N., Chan, C.,… & Wong, K.. (2013). Presentation, diagnosis, and medical management of heart failure in children: Canadian Cardiovascular Society guidelines. Canadian Journal of Cardiology, 29(12), 1535-1552.
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Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H., Conti, J. B., Deal, B. J.,… Al-Khatib, S. M. (2016). 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: A report of the American College of Cardiology. Heart Rhythm, 13(4), 136-221.