Young drunk female attends A&E with a tachycardia, approx 170 bpm. SHO diagnoses SVT and treats with
adenosine. To his surprise, tachycardia gets significantly worse; she has a few beats of what may quite reasonably
be diagnosed as VF and settles into a /faster/ rhythm at about 250.
SHO v surprised and not a little shocked, sends her to CCU. Grumbling letter returns from cardiologist that this was
the wrong thing to do; he needed cardioversion for the AF he was in; the cardiologist thinks her original rhythm was
sinus tachycardia. As it happens, I disagree and think that the presenting rhythm was AF with superb conduction.
Was it? Adenosine is the drug of choice in my humble opinion for diagnosis of rapid apparently narrow complex
tachyarrhythmias. Listed side effects do include tachyarrhythmias (actually, include almost everything, including the
slightly alarming comment that temporary pacing has been required) but I may well have tried the same. I think fast
AF is the right diagnosis all along, but has anyone heard of VF as a consequence of adenosine administration?
Best wishes,
Rowley Cottingham
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Before you criticise someone, you should walk a mile in their shoes.
That way, when you criticise them, you're a mile away and you have
their shoes.
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