Question
A young college student having regular heart rate of 172 beats per minute attends OPD for uneasy sensation in chest. Carotid sinus pressure brings down the heart rate to 72 per minute. What is the most likely diagnosis ?
The correct answer is
Paroxysmal supraventricular tachycardia
Diagnosis of Tachycardia
The patient, a young college student, presents with an uneasy chest sensation and a rapid, regular heart rate of $172$ beats per minute.
Effect of Vagal Maneuver
Carotid sinus pressure, a common vagal maneuver, was applied. This intervention successfully reduced the heart rate to a normal level of $72$ beats per minute.
Evaluating Diagnostic Options
- Ventricular tachycardia (VT): Less common in young, healthy individuals without underlying heart disease. While it can be regular, the dramatic response to vagal stimulation is less typical.
- Atrial fibrillation (AF): Characterized by an irregularly irregular pulse, which contradicts the stated regular heart rate of $172$ bpm.
- Sinus arrhythmia: A normal variation; a rate of $172$ bpm is pathologically high for sinus rhythm.
- Paroxysmal supraventricular tachycardia (PSVT): This condition involves sudden episodes of rapid heart rates originating above the ventricles. It commonly affects young people and is often characterized by a regular, fast rhythm. PSVT is frequently terminated by vagal maneuvers, as the increased vagal tone slows conduction through the AV node, interrupting the re-entrant circuit.
Conclusion
The patient's age, the sudden onset of a regular, rapid heart rate ($172$ bpm), and the termination of the tachycardia with carotid sinus pressure strongly suggest Paroxysmal supraventricular tachycardia (PSVT).
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Important Questions from General Clinical Conditions
- In which of the following SA node dysfunction conditions, permanent pacing may NOT be required?
1. Beta blocker drugs
2. Narcotic drugs
3. Iatrogenic-Post RT/Surgery
4. Hypothyroidism
5. Sick sinus syndrome
6. Raised Intracranial tension
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1. 4.5 kg over 6-12 months
2. 10 kg over 6-12 months
3. More than 5% over 6-12 months
4. More than 10% over 6-12 months
Which of the above constitute significant or clinically important weight loss? - The ‘Y' descent in JVP waveform represents:
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