• Am J Emerg Med · Jul 2020

    Case Reports

    High-dose adenosine for treatment of refractory paroxysmal supraventricular tachycardia.

    • Lily Cheng and Wesley Eilbert.
    • Department of Emergency Medicine, College of Medicine, University of Illinois at Chicago, 1819 West Polk St., Room 469 COME, Chicago, IL 60612, United States of America. Electronic address: lcheng21@uic.edu.
    • Am J Emerg Med. 2020 Jul 1; 38 (7): 1541.e3-1541.e4.

    AbstractParoxysmal supraventricular tachycardia (PSVT) is one of the more common arrhythmias requiring treatment in the emergency department. Intravenous adenosine is recommended as the initial medication of choice for treatment of PSVT, given in escalating doses up to a maximum of 12 mg. With a serum half-life of less than 10 s, adenosine must be given rapidly to allow for adequate time for it to reach the heart via venous return. In over 10% of adult patients, PSVT will not be terminated with maximum doses of adenosine. We report a case of a patient requiring a higher-than recommended dose of adenosine for termination of PSVT. The patient had a history of pulmonary hypertension with resultant right heart failure at the time of presentation. We believe the higher dose of adenosine was necessary in this patient because of the impaired venous return to her right heart. This case indicates that patients with impaired venous return to the right heart may require higher-than-recommended doses of adenosine for effective termination of PSVT.Copyright © 2020 Elsevier Inc. All rights reserved.

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