For hemodynamically stable SVT, which maneuver is typically attempted first before pharmacologic therapy?

For hemodynamically stable SVT, which maneuver is typically attempted first before pharmacologic therapy?

• A. Adenosine infusion
• B. Vagal maneuvers (Valsalva)
• C. Immediate DC cardioversion
• D. Beta-blocker bolus

Answer: (B)

When a patient has hemodynamically stable SVT, the first step is to try a nonpharmacologic way to interrupt the reentrant circuit by increasing parasympathetic tone and slowing AV nodal conduction. Vagal maneuvers, especially the Valsalva maneuver, are used because they are quick, safe, and can terminate some SVTs without drugs. If this succeeds, the rhythm may revert to normal without needing medications. If it doesn’t work, the next step is an intravenous agent like adenosine, which acts very quickly to transiently block AV nodal conduction and often terminates the SVT. Immediate DC cardioversion is reserved for patients who are unstable or deteriorating. A beta-blocker bolus is a pharmacologic option but not the typical first action in a stable patient.

When a patient has hemodynamically stable SVT, the first step is to try a nonpharmacologic way to interrupt the reentrant circuit by increasing parasympathetic tone and slowing AV nodal conduction. Vagal maneuvers, especially the Valsalva maneuver, are used because they are quick, safe, and can terminate some SVTs without drugs. If this succeeds, the rhythm may revert to normal without needing medications. If it doesn’t work, the next step is an intravenous agent like adenosine, which acts very quickly to transiently block AV nodal conduction and often terminates the SVT. Immediate DC cardioversion is reserved for patients who are unstable or deteriorating. A beta-blocker bolus is a pharmacologic option but not the typical first action in a stable patient.