I bet the young doctor got a bit of a shock but anything is possible in
medicine.
A few thoughts..
Was the patient simply drunk or was the tachycardia related to another drug
ingestion such as an amphetamine?
Adenosine is probably the safest drug to give for any tachyarrythmia which
might be SVT and worth a try if not sure of the diagnosis.
Ventricular fibrillation once established leads to death and does not
spontaneously revert. So what looked like VFib in this case was probably
VTachycardia ( just as Torsade de pointes sometimes looks like VF but the
patient has a pulse!!)
Will never forget a young woman who died on the end of a needle in 1986.
Was given Verapamil for SVT with a rate of 260 and went into a terminal
bradycardia. Pathology at post mortem : Pulmonary Embolus
All the staff were devestated.
Since then always wary of the tachycardia that is secondary to illness
rather than the primary pathology.
JohnC 

-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]]
Sent: Thursday, 2 December 1999 07:49
To: [log in to unmask]
Cc: [log in to unmask]
Subject: Adenosine


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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