by Misty1

What methods can be used to differentiate between the two? I've been looking all over for a take home test I have and the strip (wish I could post) I put SVT but wondering if it may be Atrial Flutter with fast ventricular rate.

I'm thinking of putting possible Atrial Flutter with fast ventricular rate.

Thanks if anyone can help.

Re: SVT vs Atrial Flutter

One method I like to use is to slow the sweepspeed from 25 to 50 (don't forget to tell anyone else that may be monitoting at a central computer). This will allow you to identify features specific to SVT that can be buried in the fast rhythm.

Re: SVT vs Atrial Flutter

Originally Posted by Misty1

What methods can be used to differentiate between the two? I've been looking all over for a take home test I have and the strip (wish I could post) I put SVT but wondering if it may be Atrial Flutter with fast ventricular rate.

I'm thinking of putting possible Atrial Flutter with fast ventricular rate.

Thanks if anyone can help.

Technically, A-flutter is an SVT. By definition, any tachy-dysrhythmia that is being driven by a focus above the ventricles ('supra-ventricular') is an SVT. So...if you're seeing a fast flutter but cant really see the flutter-waves, you technically wont be wrong by calling it SVT. So...for the purposes of your test...if you can call your rhythm SVT...especially if you arent seeing any flutter-waves. If you're wrong, you can split hairs and complain and likely get the points...

Re: SVT vs Atrial Flutter

Thanks. The question after the strip is How to determine AF from SVT. I've looked up in all my books and internet and can't find it. I'm sticking with SVT. and Thanks again

Re: SVT vs Atrial Flutter

If this is for a nursing exam it is a safe bet they want the super-anal-retentive nursing school answer. Therefore, yes it is techniqually all SVT. Atrial flutter is extremely regular whereas SVT can have even a slight variation in the R-R. March out your rhythm. If its for a test- this may be what they are looking for, but that's just my guess. In practice, however, if you are unsure you can call it SVT. Personally I would want to try to differentiate the two. Also, check an ECG (again, in practice).

Re: SVT vs Atrial Flutter

Thanks I didn't know the SVT was slightly irregular. I'd think it would be the other way around. Anyway I didn't know you could slow the sweep speed. That sounds like a good answer too.

Thank you again.

Re: SVT vs Atrial Flutter

I think I'd go with the obvious....SVT has a p wave (although it can be buried in the QRS and therefore hard to see)....a-flutter has flutter waves but no normal p-wave....

Re: SVT vs Atrial Flutter

Originally Posted by Misty1

Thanks I didn't know the SVT was slightly irregular. I'd think it would be the other way around. Anyway I didn't know you could slow the sweep speed. That sounds like a good answer too.

Thank you again.

You're right. Flutters are often irregular ('variable' flutters) and can be very difficult to distinguish from A-fib when going fast.
They can also be very regular (2:1 flutter, etc.)

Classic SVT will be regular because the 'short-circuit' generating the rhythm doesn't change. (A-fibs/flutters are generated by more 'generalized irritability' in the atria).

Another thing to consider is that IF you see a p-wave in true SVT it wont be the same p-wave (or have the same morphology) as the p-waves seen when the patient's in sinus. This is because in true 'classic' SVT (more correctly 'AVNRT'-or AV-node re-entrant tachycardia) the rhythm is being driven by an irritable 'focus' outside of the SA-node. SA-node p-waves are 'normal' p-waves. P-waves (if apparent) in SVT/AVNRT will look (most of the time) different from sinus p-waves because they're not coming from the SA-node..

The thing to take from this is that all of these narrow, atrial tachy-dysrhthmias can be hard to differentiate...which is why 'SVT' is an umbrella term for all of them...rather than a specific diagnosis. Many nurses fail to recognize this.

Re: SVT vs Atrial Flutter

ARGH!!!!!!!! Correct answer : Do an EKG. That was in my answer seems like sometimes we make things harder then they have to be.

Thanks to you all for your help

Re: SVT vs Atrial Flutter

yea. a 12 lead ekg is great. but if in case you don't have the time to wait around for one and if you're losing bp because of no preload. a quick way to check is with adenosine. done correctly you'll either see the flutter or stop the SVT... Hope this helps!