What we can do with sv tach 145 continues
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adult supraventricular tachycardia acute management stable unstable vagal maneuvers adenosine guideline
A sustained heart rate around 145 bpm needs prompt medical assessment, especially if it is new, persistent, or confirmed as SVT on ECG. A rate near 150 can also be atrial flutter with 2:1 conduction or sinus tachycardia, so get a 12-lead ECG rather than assuming the rhythm type.
Call emergency services now if there is chest pain, shortness of breath, fainting/near-fainting, confusion, severe weakness, low blood pressure, signs of shock, or known heart disease. An unstable tachyarrhythmia may require urgent synchronized cardioversion.
If the person is awake, stable, and this is a regular narrow-complex SVT:
- Have them sit or lie down. Do not drive.
- Check blood pressure, oxygen saturation, glucose, temperature, and obtain ECG monitoring if available.
- A clinician may first use a modified Valsalva maneuver. Do not do carotid sinus massage yourself.
- If it persists, acute treatment in a monitored clinical setting commonly includes rapid IV adenosine for regular SVT, followed by other AV-nodal treatment or cardioversion when appropriate. This must be guided by ECG and a trained clinician. ACC/AHA/HRS SVT guideline
- If the rhythm is irregular, wide-complex, or there may be pre-excitation/WPW, do not assume routine SVT treatment is safe. Urgent expert assessment is needed.
Also look for triggers or causes: dehydration, fever/infection, pain, anemia/bleeding, low oxygen, stimulant or cocaine use, thyroid disease, electrolyte abnormalities, and medication effects.
If you mean you or someone beside you currently has a continuous rate of 145, please seek emergency care now, particularly if it has lasted more than a few minutes or there are any symptoms.
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