2a) .@cpcannon & @md_pollack will be discussing patient #burden of #PSVT & take a look at current & #emerging abortive therapies. We see these patients frequently in the office and in the #ED.
— cardio-met (@cardiomet_CE) May 4, 2023
3) Paroxysmal supraventricular tachycardia #PSVT is characterized by recurrent, acute episodes of rapid heart rate that typically appears as a narrow #QRS complex on #ECG. PSVT is a common condition, est to have a prevalence of about 1 in 300 adults.https://t.co/4FIkXE1ffZ
— cardio-met (@cardiomet_CE) May 4, 2023
4b) Pts in #PSVT episodes if short in duration may be largely asymptomatic, but if prolonged duration may have debilitating #palpitations, #chestpain, #dyspnea, and #anxiety, the last of which is often high on the list of differential considerations.
— cardio-met (@cardiomet_CE) May 4, 2023
🔓https://t.co/k67dUlqKsJ pic.twitter.com/Yhybxu5l2A
4d) Definitive tx of is often difficult. #Electrophysiologic studies are usually necessary to determine the #pathophysiology of impulse formation and pathways of abnormal conduction–usually different reentry circuits in the 🫀. If circuit identified, #ablation can be curative. pic.twitter.com/m51sAyVH0e
— cardio-met (@cardiomet_CE) May 4, 2023
4f) #Atrioventricular nodal re-entrant #tachycardia(#AVNRT) and atrioventricular re-entrant tachycardia (#AVRT) together account for up to 90% of #PSVT cases.
— cardio-met (@cardiomet_CE) May 4, 2023
See 🔓 https://t.co/OfLWMw5jGB.
This is AVNRT: pic.twitter.com/MZxJUTJBGX
5b) #PSVT can also be associated with #rheumatic heart disease, acute #pericarditis, #MI, #mitralvalveprolapse, #preexcitation syndromes, and #hyperthyroidism.
— cardio-met (@cardiomet_CE) May 4, 2023
6b) More telling of the disease burden of #PSVT is the finding that expenditures in the yr before index dx were also higher for PSVT patients, despite the similarity between patients & controls on all observable characteristicshttps://t.co/dMdY3pVx80 pic.twitter.com/sYo8StTVvs
— cardio-met (@cardiomet_CE) May 4, 2023
7b) Direct-current cardioversion #DCCV is reserved for patients with #hemodynamic compromise or in whom medical therapy is ineffective or not feasible. Fortunately, most pts with acute #SVT don't need to go there!
— cardio-met (@cardiomet_CE) May 4, 2023
9) The goal of #pharmacologic management is to slow or block #AVN conduction. Agents used for this purpose include #adenosine, #CCBs (verapamil or diltiazem), & #BBs (e.g., esmolol). pic.twitter.com/Xf8bfVxJM7
— cardio-met (@cardiomet_CE) May 4, 2023
10b) Side effects include flushing, dyspnea, & chest pain. Because of short half-life, these effects are usually very brief & do not ordinarily result in complications, but they are associated w/ pt dissatisfaction & an oft-repeated request not to receive #adenosine tx again.
— cardio-met (@cardiomet_CE) May 4, 2023
11) So what about the alternatives? Treatment with #verapamil or #diltiazem can be as effective as #adenosine, but carries the risks of excess negative #chronotropism and negative #inotropism & maybe #hypotension, & also require IV administration, so 🏥 +/- 🚑.
— cardio-met (@cardiomet_CE) May 4, 2023
12b) Indeed, per 🔓https://t.co/2YqG91CTbm, mean time ➡️conversion = 32 min for combo of #diltiazem and #propranolol, 74 min for #flecainide, & 77 min for placebo). pic.twitter.com/8snYwxUK4U
— cardio-met (@cardiomet_CE) May 4, 2023
13b) 👃 Nasal #Etripamil is metabolized by ubiquitous serum esterases.
— cardio-met (@cardiomet_CE) May 4, 2023
👃It slows #AVN conduction & prolongs AVN refractory periods via inhibition of slow inward calcium channels.
14) Ph 2 data 🔓https://t.co/jrEvqeVbyt indicated that #etripamil was safe & effective during electrophysiological testing in patients with previously documented SVT who were induced into SVT prior to undergoing a catheter ablation. pic.twitter.com/VKKFDqArqq
— cardio-met (@cardiomet_CE) May 4, 2023
16a) Let's sum up:
— cardio-met (@cardiomet_CE) May 4, 2023
🫀 #PSVT is relatively common, unpredictable arrhythmia assoc'd with poor #QoL & excessive healthcare expenditures.
🫀 Chronic 💊 often unsuccessful
🫀 Not all #PSVT pts interested in or eligible for ablation, which is generally reserved for refractory cases
16c) Intravenous #adenosine is safe and is usually successful (though repeat dosing often required), but requires an IV line & administration by an emergency physician, nurse or paramedic.
— cardio-met (@cardiomet_CE) May 4, 2023
🏥+/- 🚑 = 💰 + ☹️.
Back-up #CCBs and #BBs also require 💉.
17a) So what have you learned?
— cardio-met (@cardiomet_CE) May 4, 2023
Which of the following patients is most likely to present with acute #PSVT?
18a) #Etripamil is being studied for abortive tx of acute #PSVT in what fashion?
— cardio-met (@cardiomet_CE) May 4, 2023
19) You just earned 0.5h🆓CE/#CME! Claim it NOW at https://t.co/NnlRcScgtU & then FOLLOW US so you don't miss the next installment of expert-authored #cardiometabolic #MedEd delivered entirely on Twitter!
— cardio-met (@cardiomet_CE) May 4, 2023
We are @cpcannon & @md_pollack, and we thank you for joining us!