# Paroxysmal tachycardia - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - 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) - Verified date: 2026-08 ## 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) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text PAROXYSMAL TACHYCARDIA 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 against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - Palpitations, a full feeling in the neck, anxiety and tiredness make up the usual complaint [anxiety · fatigue · palpitations] - Feeling dizzy and feeling the heart pound are the two commonest [dizziness] - Others report blackout, nausea, breathlessness, chest pain, sweating, and heavy urine output driven by atrial natriuretic factor released on atrial stretch [breathlessness · chest pain · nausea · sweating · syncope] - How severe it feels depends on structural heart disease, how often attacks come, and the haemodynamic reserve - Sufferers tend to give up exercise and outdoor sport, so that history is worth taking - Where coronary disease is known, the attack may declare itself as a myocardial infarction [ischaemia] - Where heart failure is known, it may tip into acute decompensation - Repeated attacks, atrial tachycardia above all, can cause fresh heart failure through a tachycardia-induced cardiomyopathy [tachycardia] SIGNS - what you find (3) - During the attack: fast rate, distended neck veins, sometimes a loud first sound; a third sound instead suggests cardiomyopathy with decompensation [raised JVP] - Examination is often unremarkable; its worth lies in excluding structural and valvular disease - Breathing rate, blood pressure, temperature and pulse together show whether the patient is stable TESTS (12) - A 12-lead ECG is the first test; compare it against a sinus rhythm tracing if one exists - Read the rate, the shape of the P wave, how P relates to QRS, and the QRS shape - A narrow QRS is the hallmark, though bundle branch block, aberrancy tied to rate, or preexcitation can widen it - RP shorter than PR defines short RP tachycardia: typical AVNRT heads the list, then orthodromic AVRT - RP longer than PR excludes typical AVNRT and leaves atrial tachycardia, atypical AVNRT, or AVRT down a decremental pathway - In typical AVNRT the retrograde P sits inside the QRS, since atria and ventricles fire together - Atypical AVNRT instead shows separate retrograde P waves inverted inferiorly, with RP normally exceeding PR - In sinus rhythm a short PR with a delta wave betrays preexcitation, though its absence does not exclude orthodromic AVRT - Focal atrial tachycardia shows one clear P wave and a long RP, shaped unlike the sinus P - Atrioventricular dissociation rules AVRT out entirely - These ECG features sort out over 80% of cases; the other 20% need an electrophysiology study - Selected patients also warrant renal function, electrolytes and thyroid tests, plus transthoracic echo for left ventricular function and structural disease IF NOT THIS - what else fits (10) - Atrioventricular nodal reentrant tachycardia - Atrioventricular reentrant tachycardia over an accessory pathway - Focal atrial tachycardia - Multifocal atrial tachycardia - Atrial flutter - Atrial fibrillation - Inappropriate sinus tachycardia - Sinoatrial node reentrant tachycardia - Junctional ectopic tachycardia - Nonparoxysmal junctional tachycardia Source StatPearls "Paroxysmal Supraventricular Tachycardia" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult 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. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why 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. Caution 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. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)