bosang...bah.2

tengah hari tadi, kira-kira 2 jam selepas aku bangun tido (al-maklumlah, cuti sem, kena penuhi dengan aktiviti yang bermanfaat) kawan aku pn balik dari maen ski. wah...sume bercerita pasal ski. salji tebal la, snow boarding la, bla bla...ah...bosan ah. mereka balik dengan keadaan yang happy (walaupun ramai yang trauma sebab eccident mase main ski), aku pun happy gak beb. coz tido adalah sesuatu yang amat aku gemari. dalam kelas, dalam lecture, tengok tv, membaca dan mase tengah bercakap pun kadang-kadang aku bole tertidur...tapi janganla samakan aku dengan Pak Lah.
habis sume website aku jelajahi...ah..bosan gak. buka tv, bosan gak. ish-ish, naik jemu aku duk kt bilik ni..last-last aku buat revision. hm...membaca pn salah satu hobby aku gak ape. so aku membaca la pasal ECG. minat betul aku ngan ECG ni. aku tak la bercite-cite menjadi seorang cardiologist (pakar jantung). cadangan aku, lepas grad nanti kerja barang 2-3 tahun, pastu aku nak buat post graduate. aku minat sangat dengan traumatology, takpun emergency medicine (ni sume gara-gara banyak sangat menonton grey's anatomy dan e.r). tapi cerita-cerita tersebut aku rasa ada gak mendatang faedah pada aku. yelah, ari tu mase prakticle kt HTAA kuantan, aku duk kt emergency department. saje-saje ah nak duk kt situ. suddenly, datang satu case budak lelaki melayu complaint of palpitation (erm..aku tak tau ar ape org melayu panggil, tp lebih kurang camni ar...budak tu tiba2 aje rase jantung die berdegup dengan kadar yang sangat laju). budak ni baru umur 16thn. ada history I.E (infective endocarditis). apalagi, dr kt citu order ar ECG. finding...supraventricular tachycardia. doctor tu pun tanya aku (saje je nk uji aku): what should we do?? aku cakap kalau tak salah saya buat carotid sinus massage. betulla plak..hehehe. kembang kempis hidung aku ni...die tanya aku, mana awak baca pasal ni?? aku cakap aku tengok dalam grey's anatomy. bayangkan, begitu sekali aku menghayati citer grey's anatomy ni (of course la aku akan confirm balik dengan buku lepas aku tengok). hehehe...aku duk tunggu citer grey's ni dah agak lama. kalau x salah aku, episode sebelum ini released on 10th jan. kat2 sebulan yang lepas. aku chek td, grey's kuar ari ni..yeye, seronok. penantian satu penyeksaan beb. dan pastinye penyeksaan aku berakhir sebentar aje lagi...
oh ya. dalam kul lapan lebih td, aku escort syazwan (roomate aku) pegi buat x-ray kaki die...ni sume gara-gara main snow board. ade ke die pegi langgar pokok. lah, pokok yang x gerak tu pun ko pergi langgar, ape kes..langgar la lori balak ker, tak pun ko pegi langgar militsia (polis) kt tepi jalan tu...lagi baik. berbalik kepada kisah kawan aku td, aku pun ikut la mamat ni. doktor-doktor kt trauma bay tu bapak la sombong nye. apela, diorg ni tak belaja deontology kot! malas ah aku nk cite ape yang diorg buat, tp memang takleh diterima akal. sampah betul! ko kalau tanak jadi doktor pegi la jual bulochka (roti), tak pun pirazhok (pie) kt tepi jalan!! kalau nak jadi doktor, buat cara nk jadi doktor. hah, tension aku dengan mentaliti russian-russian kat cni...

SUPRAVENTRICULAR TACHYCARDIA

upraventricular tachycardia (SVT) is an abnormal fast heart rhythm that starts in the upper chambers, or the atria, of the heart. ("Supraventricular" means above the ventricles, "tachy" means fast, and "cardia" means heart.)

Normally, the heart's electrical system precisely controls the rhythm and rate at which the heart beats. In supraventricular tachycardia, abnormal electrical connections (or abnormal firing of the connections) cause the heart to beat too fast. Typically, during supraventricular tachycardia episodes, the heart speeds up to rates of 150 to 200 beats per minute and occasionally as high as 300. After some time, the heart returns to a normal rate (60 to 100 beats per minute) on its own or after treatment.





Supraventricular tachycardia (SVT) is also called paroxysmal supraventricular tachycardia (PSVT) or paroxysmal atrial tachycardia (PAT).
What are the different types of supraventricular tachycardia?

Sometimes it is normal to have an increased heart rate-for example, during exercise, with a high fever, or when under stress. This fast heart rate, called sinus tachycardia, is a normal response to these stressors and is not considered a medical problem. This topic addresses the types of supraventricular tachycardias that are considered abnormal. These include:

* Atrioventricular nodal reentrant tachycardia (AVNRT), the most common type (after atrial fibrillation).
* Atrioventricular reciprocating tachycardia (AVRT), including Wolff-Parkinson-White syndrome.

What causes supraventricular tachycardia?

Most supraventricular tachycardia results from abnormal electrical connections in the heart that short-circuit the normal electrical system. What causes these abnormal pathways is not clear. In the case of Wolff-Parkinson-White syndrome, the condition may be inherited.

Overly high levels of the heart medicine digoxin (such as Lanoxicaps or Lanoxin) can cause some types of supraventricular tachycardia (such as Wolff-Parkinson-White syndrome) to get worse. However, digoxin may be used to treat some other types of SVT (such as atrial fibrillation). In rare cases, conditions that affect the lungs-such as chronic obstructive pulmonary disease (COPD), or pneumonia-can also cause a type of SVT called multifocal atrial tachycardia (MAT).

What are the symptoms?

With supraventricular tachycardia, you may have palpitations, an uncomfortable feeling that your heart is racing or pounding. You may also notice that your pulse is rapid or see or feel your pulse pounding, especially at your neck, where large arteries are close to the skin. Additional symptoms include feeling dizzy or lightheaded, near-fainting or fainting (syncope), shortness of breath, chest pain, throat tightness, and sweating.
How is supraventricular tachycardia diagnosed?

A description of your symptoms is one of the most important clues in diagnosing supraventricular tachycardia. Your doctor will ask what, if anything, triggers the episodes, how long they last, if they start and stop suddenly, whether anything stops them, and whether the beats are regular or irregular. Because supraventricular tachycardia is a problem with your heart's electrical system, the most important test is an electrocardiogram (EKG, ECG). An EKG measures the heart's electrical activity and can record supraventricular tachycardia episodes. An EKG is usually done along with a medical history and physical examination, lab tests, and a chest X-ray.

If you do not have an episode of supraventricular tachycardia while at the doctor's office, your doctor will probably ask you to wear a portable EKG to record your heart rhythm on a continuous basis. This is referred to by several names, including ambulatory electrocardiogram, ambulatory ECG, Holter monitoring, 24-hour EKG, or cardiac event monitoring. This will allow your heart rhythm to be recorded while you are having supraventricular tachycardia.

Your doctor may also recommend an electrophysiology (EP) study. In this test, flexible wires are inserted into a vein, usually in the groin, and threaded into the heart. Electrodes at the end of the wires send information about the heart's electrical activity. In this way, the EP study can map any abnormal electrical activity, identify the type of supraventricular tachycardia you have, and guide treatment.

How is it treated?

Some supraventricular tachycardias do not cause symptoms and may not need treatment. However, when symptoms occur, treatment is usually recommended.





What is recommended to treat an episode of SVT?

* Treatment must only be undertaken in hospital, as full ECG monitoring and resuscitation facilities are needed.
* Vagal manoeuvres (e.g. Valsalva, carotid massage, facial immersion in cold water) may terminate an episode of SVT.
* Intravenous drug treatment is required if vagal manoeuvres fail:
o Intravenous adenosine is the treatment of choice except for people with severe asthma. Adenosine has a rapid onset and short half-life. It blocks conduction through the AV node.
o Intravenous verapamil, although effective, is rarely used now. It has a more prolonged action than adenosine on blocking AV node conduction, and there is a risk of prolonged depression of ventricular function, especially if the person is taking a beta-blocker. It still has a place if adenosine is contraindicated (e.g. in somebody with severe asthma) [Chun and Sung, 1995; Ganz and Friedman, 1995].
* DC cardioversion is the most effective and rapid treatment if the person is haemodynamically unstable.

Which treatments are recommended to prevent further episodes of SVT?

* Long-term preventative treatment is not required in all people. The frequency and severity of the episodes of SVT need to be balanced against the risks of long-term therapy.
* The choice of maintenance therapy depends on the underlying type of SVT.
* Anti-arrhythmic drug therapy is used in many people to prevent further episodes. The choice of which drug (from which anti-arrhythmic class) for the different types of SVT is beyond the scope of this guidance. All anti-arrhythmic drugs have adverse effects, and, as they need to be taken long-term, it is important to consider referral for consideration of radiofrequency catheter ablation.
* Radiofrequency catheter ablation is associated with a high success rate and low complication rate for people with SVT. Radiofrequency catheter ablation is indicated in the following situations:
o As first-line therapy as a curative option.
o If the SVT is refractory to anti-arrhythmic drug therapy.
o If the person is intolerant of anti-arrhythmic drug therapy.
o If anti-arrhythmic drug therapy is contraindicated.