Supraventricular Tachycardia For TKR

PIG Meeting: 22nd April 2021

78-year-old lady with history of SVT.

Background

  • 40-year history of episodes of SVT
  • Self-limiting but symptomatic. Last episode March 2021, came to ED but had self-terminated
  • Reviewed by cardiologist 10+ years ago. Normal echo and angiogram.
  • On metoprolol, no decrease in frequency of episodes
  • Multiple previous surgeries with no issues

Discussion

1. Preoperative Investigations

  • Should we organise Holter monitor and cardiology review pre-op?
  • Useful in setting of deciding on requirement for post-operative telemetry bed
  • No cardiology review for many years, may be offered different therapy. See AHA algorithm below.
  • Treatment of SVT in perioperative setting discussed

2. Postoperative care

  • ? Cardiac monitoring required post-operatively
  • Telemetry bed may be preferred

Plan

  • Outpatient Holter monitor
  • Discuss at cardiology meeting with results
  • Consider telemetry monitoring post-operatively in consultation with Cardiology
  • Check electrolytes and TFT’s
AHA 2015: Ongoing management of SVT of unknown mechanism.
SHD, structural heart disease (including ischemic heart disease); and SVT, supraventricular tachycardia.

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