Investigations for the assessment of adult patients presenting to the emergency department with supraventricular tachycardia

Abstract

Patients with supraventricular tachycardia (SVT) commonly present to the emergency department (ED). Current guidelines [1,2] do not recommend routine pathology testing and a report on the topic has questioned their role. A systematic review concluded that troponin testing is commonly performed with a high proportion of positive fi ndings, but these results were not associated with major adverse cardiac events. [3] The conclusions of this review were limited by paucity of data and heterogeneity among studies. Unnecessary and/or inappropriate investigations in the ED have been associated with adverse effects. False-positive results or incidental findings may lead to unnecessary investigation, at the risk of the true pathology being ignored. It is also important with respect to utilisation of resources, particularly in Australia where costs to the health care system are substantially borne by the taxpayer. [4] Evidence-based implementation of protocols for investigations, education program for medical staff and audit/feedback processes have been previously associated with safe and efficient diagnostic practices. [5] Among patients presenting to the ED with SVT, we aimed to describe adjunct investigations and assess whether the results of such investigations influenced management in the ED.

Troponin Testing in Adult Patients Presenting to the Emergency Department for Paroxysmal Supraventricular Tachycardia: A Review

“…4,13 Approximately one-third (30–33%) of patients receiving troponin in ED after a PSVT episode (excluding those with atrial flutter or atrial fibrillation) had elevated levels. 13,14,17 Factors associated with cTn positivity varied across the studies. History of CAD was the most frequently reported, other factors being chest pain, maximum heart rate or ST segment depression during arrhythmia, PSVT duration, creatinine concentration, age, and diabetes mellitus (Table 3 for details).…”

“…10 Since 2007, some observational cohort studies have been published assessing the role of cTn as a diagnostic marker of CAD in adult patients with PSVT. [11][12][13][14][15][16][17] Table 1 shows the main features of the studies available on this topic. Most of them are retrospective, monocentric, with a small sample, and the setting is generally ED.…”

Troponin Testing in Patients With Supraventricular Tachycardia—Are We Overtesting?

“…Fortunately, SVT is rarely life-threatening and has a favorable prognosis, being most common in a relatively younger population without ischemic heart disease . However, despite a lack of supporting evidence, a proportion of patients will undergo low-yield testing, including troponin (48%-77%), complete blood cell count (81%-93%), electrolyte levels (84%-93%), thyroid function (18%-46%), and chest radiography (30%-33%) …”

“…In the absence of acute coronary occlusion, an elevated troponin level in the setting of SVT is likely to be secondary to coronary ischemia that occurs with increased oxygen demand or shortened diastole . Moreover, the typical patient with SVT will have a low pretest probability for coronary artery disease, and positive troponin test results are relatively more likely to be false positive for acute coronary occlusion.…”