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Atrioventricular Nodal Reentrant Tachycardia (AVNRT)
Overview:
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Atrioventricular Nodal Reentrant Tachycardia (AVNRT) is a type of supraventricular tachycardia characterized by a fast heart rate. It involves the atrioventricular (AV) node of the heart and its properties of conduction and refractoriness.
Mechanism:
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AVNRT typically occurs due to the presence of two distinct pathways within or near the AV node: a fast pathway and a slow pathway.
Under normal circumstances, electrical impulses move down the fast pathway. However, a premature atrial contraction can lead to a situation where the fast pathway is still refractory (unable to transmit an impulse), while the slow pathway can conduct the impulse.
This situation sets up a reentrant circuit, where the electrical impulse travels down the slow pathway and back up the fast pathway, leading to tachycardia.
Clinical Presentation:
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Patients usually present with sudden onset and offset of palpitations.
Other symptoms can include chest discomfort, shortness of breath, dizziness, or even syncope (fainting) in some severe cases.
The heart rate during an episode of AVNRT is usually between 150-250 beats per minute.
Diagnosis:
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AVNRT is typically diagnosed via an electrocardiogram (ECG) during an episode. However, it may require an electrophysiology study in cases where the diagnosis is not clear.
On an ECG, AVNRT often presents as a narrow complex tachycardia (the QRS complex is less than 120 milliseconds) with absent or retrograde P waves.
Treatment:
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Initial management often involves maneuvers that increase vagal tone, such as the Valsalva maneuver or carotid sinus massage.
If these fail, intravenous medications like adenosine or calcium channel blockers (verapamil or diltiazem) may be used.
In refractory cases or for patients with frequent recurrent episodes, catheter ablation of the slow pathway can provide a definitive cure.
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