Q: 78 year old male admitted 2 days ago with Transient Ischemic Attack(TIA) and community acquired pneumonia to ICU. Patient developed SVT(Supraventricular Tachycardia) with Heart Rate of 190 causing hypotension. All of the following can be part of management except?

A) IV fluid(IVF)
B) Carotid sinus massage
C) Oxygen to counter hypoxemia
D) Cardioversion
E) Adenosine 



Answer: B

According to guidelines from various societies carotid sinus massage should not be performed in patients with TIA or CVA (cerebrovascular accident) within last three months. Also, it should be avoided in patients on side of carotid artery stenosis or on patients with carotid artery bruit.

IVF is an integral part of management in hemodynamic instability with arrhythmia.

Hypoxemia can be a major trigger of SVT in patients with respiratory disease and oxygen should be administer to counter it.

Cardioversion and Adenosine are both viable options in management of SVT. 



 References:

1. Task Force for the Diagnosis and Management of Syncope, European Society of Cardiology (ESC), European Heart Rhythm Association (EHRA), et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30:2631

2. Strickberger SA, Benson DW, Biaggioni I, et al. AHA/ACCF Scientific Statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: in collaboration with the Heart Rhythm Society: endorsed by the American Autonomic Society. Circulation 2006; 113:316.