Medical Treatment

If you have low blood pressure, chest pain, or a failing heart with tachycardia, your condition is considered unstable. In such cases, you may be in serious danger and need immediate treatment. You may need an electrical shock (cardioversion) to convert your heart to normal rhythm. If your condition is stable, a number of options are available to end the abnormal rhythm:

• Vagal maneuvers: Coughing, holding your breath, immersing the face in cold water, and tensing your muscles as if having a bowel movement are called vagal maneuvers because they increase the tone of the vagus nerve on your heart. Increased vagal tone stimulates release of substances that decrease your heart rate, which can break the abnormal electrical circuit.
  
  
• Carotid massage: Carotid massage involves gently pressing and rubbing your carotid sinus, located in your neck just under the angle of your jaw. Carotid massage can release chemicals to slow your heart rate. This step is generally limited to young, healthy people because older people are at risk of stroke. You will be connected to a heart monitor because the decrease in heart rate can be dramatic.
  
  
• Medications: You may be given adenosine (Adenocard), a short-acting medication that decreases your heart rate. This medication is given by IV to act quickly. Adenosine has some temporary side effects, including facial flushing, chest pain, shortness of breath, nausea, and dizziness. If a single dose does not stop supraventricular tachycardia, then your doctor may give higher doses. Adenosine successfully stops paroxysmal supraventricular tachycardia (PSVT) in more than 90% of cases.
  
  
• If adenosine is unsuccessful, other medications can be used, such as calcium channel blockers, digoxin (Lanoxin), or beta-blockers.

Your health care provider will devise treatment that meets the specific cause of your supraventricular tachycardia.

• Pacemaker: A pacemaker is an electronic device that takes over the role of the SA node as pacemaker of the heart. It is often implanted inside the heart by a cardiologist in the cardiac cath lab, not by a surgeon in the typical operating room.
  
  
• In special cases, the source of your arrhythmia or abnormal electrical pathways can be interrupted by chemicals, ablated by high frequency energy through a catheter (such as in the Wolff Parkinson White syndrome), or by a surgeon.

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