PSVT in a pedi causing pulmonary edema?

[04_edge]

Im not real sure where this should go but...

Last week in class we were running through pedi assesments for PEPP. I cant remember exactly how the call came in, or the specifics on the pt. but from what i remember it was a ~10yo in SVT with SoB and low RaSpo2(i think it was around 85-90) with NPMH. Basically what it amounted to was the PSVT caused pulmonary edema. Ive been trying to think this through, but im just not seeing it. To me it seems that since neither the left or right ventrical are pumping adequately at that rate(IIRC it was 220-240) that you would see peripheral edema well before it backed up into his lungs.

Is this possible/Has anyone seen this on an actual patient before?

 

[MSDeltaFlt]

Not necessarily. Rates that fast can cause either one first. Peripheral edema is not as dangerous as pulmonary edema. One can have left heart failure without right heart failure. However, if one has right heart failure, they will eventually get left heart failure as well.

 

[WTEngel]

I have never seen pulmonary edema as a sole direct result or PSVT, but that doesn't mean it could not happen.

Rapid rhythms do decrease cardiac output which can cause edema, both systemic and pulmonary. Depending on a number of factors, it may manifest itself in either area first.

If I saw a pediatric patient with pulmonary edema and SVT, I would consider that there is probably a third problem, perhaps a cardiac defect or congenital heart disease, neither of which Most pre hospital providers are going to do anything about, unless you suspect pulmonary HTN or a ductal dependent defect and can start PGE or some off the wall scenario....yada yada yada....

Treat the treatable, and remember this is likely not a standard CHF pulmonary edema situation and you're treading into very specialized waters. Testicular hypertrophy backed by sound skills and experience may be necessary to get to the hospital in one piece.

I would chalk this particular scenario up to something designed to make you think a little outside of the box, likely taught by someone without a lot of pediatric experience who lacked the knowledge to really expand on the intended concept of the scenario.

 

[Veneficus]

classic physiology

It looks to me like this scenario was made up using basic textbook physiological concepts.

When you have a heart that has reduced output in the LV, the back up is a few inches in the pulmonary circuit leading to the lungs. Which would give you the pulmonary edema.

However, like most of these pathetic 2 day courses, esecially ones designed specifically for EMS, they neglect to account that not only does the LV ejection fraction decrease because of the rate, but so would the RV ejection, which would lead to a back up of fluid in the systemic circuit first manifest in the liver, before the periphery as well.

Realistically since this lack of LV output would reduce what is going back into the right heart (CVP), there likely would be complete cardiovascular collapse in a very short time with much more profound findings.

I think it is just a bogus scenario, designed to demonstrate a very basic concept, to the lowest common denominator of provider, in order to get them to recite textbook treatments with the illusion that there is some clinical science behind it.

Like WT said, the pathologies that would cause such a presentation are beyond the standard emergent treatments for SVT.

 

[04_edge]

Thanks for the input. You all basically summed up what i was thinking in that, theoretically it is possible, but highly unlikely with the given presentation.