Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
Palpitations (rapid, fluttering heartbeat)
Lightheadedness or dizziness
Chest discomfort (may or may not be present)
Shortness of breath (may or may not be present)
History of Present Illness:
Onset, duration, and frequency of episodes.
Precipitating factors (e.g., exercise, emotional stress).
Symptoms during episodes (palpitations, lightheadedness, chest discomfort,
shortness of breath).
Duration of each episode (spontaneous termination or intervention
needed).
Response to previous interventions (e.g., vagal maneuvers, medication).
Past Medical History:
Underlying structural heart disease (e.g., congenital heart defect,
myocarditis).
Previous surgeries (e.g., cardiac ablation for arrhythmias).
Medical conditions that may contribute to arrhythmias (e.g., hyperthyroidism,
electrolyte imbalances).
Family History:
Family history of arrhythmias.
Medications:
List of current medications, including any medications used to treat
AVRT (e.g., beta-blockers, calcium channel blockers).
Physical Examination:
Vital signs: Assess for heart rate (regular vs. irregular tachycardia)
and blood pressure.
Cardiac auscultation: Listen for any abnormal heart sounds (e.g.,
murmurs) suggestive of structural heart disease.
Electrocardiogram (ECG):
12-lead ECG: Demonstrates characteristic findings of orthodromic AVRT
during an episode (narrow QRS complex tachycardia with a specific P wave
morphology in relation to the QRS complex).
Holter monitoring or event recorder: May be used to capture electrocardiographic evidence of AVRT if not readily apparent on a standard
ECG.
Additional Tests (if indicated):
Echocardiogram: To assess for structural heart disease that may be
contributing to AVRT.
Electrophysiological study (EPS): An invasive test that can definitively
diagnose AVRT and identify the specific reentrant circuit.
Assessment:
Orthodromic Atrioventricular Reentrant Tachycardia (AVRT): Based on
clinical presentation (symptoms and ECG findings) and may be confirmed
with additional tests (e.g., Holter monitoring, EPS).
Trigger factors: Identify potential triggers for AVRT episodes
(e.g., exercise, emotional stress).
Hemodynamic status: Assess the impact of AVRT on the patient’s
overall health (stable vs. unstable).
Differential Diagnoses:
Consider other conditions that may mimic AVRT:
Supraventricular tachycardia (SVT) from other foci (e.g., atrial
tachycardia)
Ventricular tachycardia (VT) (wider QRS complex on ECG)
Panic attack (symptoms may overlap)
Plan:
Treatment options: Choice of treatment depends on the frequency of
episodes, severity of symptoms, and patient preference. Options may
include:
Vagal maneuvers (Valsalva maneuver) for termination of acute episodes.
Medications:
Beta-blockers or calcium channel blockers to control heart rate
and prevent recurrence.
Catheter ablation: Minimally invasive procedure to permanently
disrupt the reentrant circuit causing AVRT.
Long-term management: Regular follow-up to monitor symptoms,
evaluate treatment response, and address any complications.
Patient education: Educate the patient about AVRT, trigger factors,
treatment options, and potential risks and benefits of each treatment.
Instruct the patient on how to recognize and manage symptoms.
Prognosis:
With appropriate treatment, most patients with AVRT can achieve good
symptom control and improve their quality of life. Catheter ablation
offers a high success rate for long-term cure.