1. Minimize unnecessary laboratory testing in young, healthy patients who quickly respond to treatment. While hyperthyroidism, electrolyte abnormalities, anemia, and drug/alcohol use have all been associated with SVT, it is unlikely that all of these etiologies need to be investigated in every single patient. A focused history and physical examination will help guide which, if any, laboratory testing is appropriate. Additionally, if a patient discloses that he/she abuses drugs or alcohol, a confirmatory test is likely unnecessary.
2. Avoid routinely sending cardiac enzymes and avoid admitting patients with SVT for acute coronary syndrome (ACS) evaluation. While certain forms of SVT (e.g., NPJT) may be associated with ACS/MI, most patients with SVT do not require evaluation for cardiac ischemia. In fact, ordering cardiac enzymes in all patients with SVT can be a dangerous approach that leads to unnecessary antianginal therapy and invasive testing. Several studies have shown that markers of cardiac ischemia (troponin I) can be elevated, but that patients do not have significant coronary artery disease on further evaluation. Of course, in patients in whom you suspect cardiac ischemia or who have significant risk factors, appropriate evaluation is indicated and may include serial cardiac enzymes and admission.
3. Give the patient a copy of their ECG documenting a prior SVT or evidence of ventricular preexcitation and ask them to carry it at all times. An ECG contains valuable information that may be useful when the patient presents for follow-up, returns to your ED with recurrent symptoms, or visits an outside hospital where the providers don’t have immediate access to prior ECGs. It is a simple, inexpensive intervention but may result in more efficient and appropriate treatment and a decrease in unnecessary testing/work-up.
Purchase the individual issue for 2 more cost effective tips
Posted by empracticenews 
