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40.4 Definitions, clinical presentation, symptoms, quality of life, and patient preferences
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Published:July 2018
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Abstract
The term supraventricular tachycardia (SVT) refers to all tachycardias originating from supraventricular tissue (i.e. the sinus node, atria, or atrioventricular junction) or requiring it for their maintenance. Paroxysmal SVT is a clinical syndrome characterized by a tachycardia with an abrupt onset and termination. Non-paroxysmal SVTs have a gradual onset and offset sometimes characterized by the ‘warm-up’ and ‘warm-down’ phenomena. The term incessant is used to describe continuous SVTs, or repetitive SVTs recorded during 90% or more of the monitoring period. Clinical presentation of SVT is heterogeneous, depending on the SVT type, the patient’s age, and underlying comorbidities. Some SVT patients may be asymptomatic or minimally symptomatic. Symptoms related to SVTs include palpitations, lightheadedness, dizziness, diaphoresis, chest discomfort or chest pain, shortness of breath/dyspnoea, anxiety, polyuria, presyncope, and syncope, which may have different causes (cardiogenic syncope, vasovagal reflex syncope, or syncope due to sinus node dysfunction). A detailed appreciation of the SVT pattern (e.g. abrupt or gradual onset/offset), frequency of episodes, duration, symptoms (e.g. regular fast heart beating, or irregular palpitations), and possible triggers may aid the interpretation of the electrocardiogram tracings and definite diagnosis. Although SVTs are generally more common in younger, healthy individuals, a variable disease course may significantly alter the patient’s quality of life. Many SVT patients have insufficient knowledge about their disease and available treatment. Patient education can improve their understanding of the disease and facilitate active participation of patients in the informed, shared decision-making regarding treatment.
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