Article Text

Download PDFPDF
Refractory narrow complex tachycardia in pregnancy
  1. Mathew Bloch
  1. Emergency Medicine, Prince Charles Hospital, Merthyr Tydfil CF47, UK
  1. Correspondence to Dr Mathew Bloch, Emergency Medicine, Prince Charles Hospital, Merthyr Tydfil CF47, UK; mathew.bloch{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


A woman in her early 30s self-presents to her local ED at 03:00 hours and is brought from triage to resus due to a tachycardia of 220 beats per minute (bpm). She is 15 weeks into her first (twin) pregnancy, has no medical history and takes no regular medication. She reports a 2-day history of intermittent ‘palpitations’ which are now constant. She describes feeling presyncopal on standing with some mild chest discomfort and shortness of breath. Examination is unremarkable other than a tachycardia. Other vital signs are BP 93/67 mmHg, RR 24 breaths per minute, SpO2 99% on room air and temperature 36.3°C. An ECG (figure 1) is performed and intravenous access is obtained.

Figure 1

Narrow complex regular tachycardia

Question 1: What does this ECG show and how does her pregnancy affect your initial management?

Answer 1: A regular, narrow complex tachycardia. In V2, there appear to be p waves prior to each QRS but they are not clear on other leads. Combining the history of intermittent palpitations, the extreme tachycardia and the ECG findings, this patient was managed following supraventricular tachycardia (SVT) guidelines as the whole clinical picture did not fit a sinus …

View Full Text


  • Handling editor Richard Body

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.