{
  "schema_version": 1,
  "kind": "condition",
  "id": "paroxysmal-tachycardia",
  "name": "Paroxysmal tachycardia",
  "category": "acute",
  "sources": "ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD69 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Supraventricular Tachycardia - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK441972/ · Paroxysmal Supraventricular Tachycardia - StatPearls - NCBI Bookshelf - disease-level clinical article (paroxysmal-tachycardia-full.txt)",
  "review_status": "reviewed",
  "verified_against": "No dose - referral pathway, no medicine given in primary care · Paroxysmal Supraventricular Tachycardia - StatPearls - NCBI Bookshelf - disease-level clinical article (paroxysmal-tachycardia-full.txt)",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 1344,
      "generic": "No drug therapy in primary care (Referral & Advice)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "Paroxysmal tachycardia presents with sudden episodes of palpitations. Primary care management requires immediate 12-lead ECG recording during symptoms to identify the rhythm mechanism (e.g. SVT vs VT vs WPW). If the patient is hemodynamically stable, attempt vagal maneuvers (e.g. Valsalva maneuver); if unstable (hypotension, altered mental status, chest pain) or if WPW is present, arrange immediate emergency transfer for electrical cardioversion or specialized antiarrhythmic therapy.",
      "adult_duration": "Refer, with advice",
      "dose_source": "No dose - referral pathway, no medicine given in primary care",
      "rationale": "Paroxysmal tachycardia presents with sudden episodes of palpitations. Primary care management requires immediate 12-lead ECG recording during symptoms to identify the rhythm mechanism (e.g. SVT vs VT vs WPW). If the patient is hemodynamically stable, attempt vagal maneuvers (e.g. Valsalva maneuver); if unstable (hypotension, altered mental status, chest pain) or if WPW is present, arrange immediate emergency transfer for electrical cardioversion or specialized antiarrhythmic therapy.",
      "cautions": [
        "RED FLAG - Ventricular fibrillation or rapid ventricular response in pre-excited atrial fibrillation (Wolff-Parkinson-White): assess urgently and refer.",
        "Syncope or near-syncope, chest pain during episodes, haemodynamic instability, pre-excitation pattern on ECG.",
        "No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.",
        "RED FLAG - Syncope, rapid atrial fibrillation, or LV dysfunction in patients with SVT or preexcitation indicate severe disease requiring specialist referral for catheter ablation.",
        "RED FLAG - Recurrent symptomatic SVT with unclear arrhythmia mechanism or syncope with inconclusive noninvasive testing warrants electrophysiology study referral.",
        "RED FLAG - Do not prescribe AV-nodal blocking drugs to a patient with manifest pre-excitation and symptomatic supraventricular tachycardia; they speed conduction of atrial fibrillation down the accessory pathway and raise the risk of ventricular fibrillation.",
        "Carotid sinus massage is contraindicated when a carotid bruit is present, and vagal manoeuvres overall terminate fewer than 30% of episodes.",
        "Frequent episodes, especially atrial tachycardia, can cause new-onset heart failure through tachycardia-induced cardiomyopathy.",
        "RED FLAG - In older patients and those with coronary disease a very fast rate can provoke myocardial ischaemia, and incessant episodes can rarely degenerate into life-threatening ventricular arrhythmias.",
        "Arrange a transthoracic echocardiogram to assess left ventricular systolic function and exclude structural heart disease.",
        "Look for and correct reversible triggers: physical exertion, stress, caffeine, nicotine, hyperthyroidism, myocardial ischaemia, infection, hypoxia and hypovolaemia.",
        "In a patient taking digoxin, consider digoxin toxicity as a cause of the tachycardia.",
        "RED FLAG - Explain the risk of sudden cardiac death to patients with Wolff-Parkinson-White syndrome and recommend catheter ablation as the primary treatment."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "paroxysmal-tachycardia"
    }
  ]
}