What is the treatment for unstable SVT with hypotension in alert patients?

The treatment for unstable supraventricular tachycardia (SVT) with hypotension in alert patients is the administration of adenosine. This is a rapid-acting antiarrhythmic that works by temporarily interrupting the conduction through the atrioventricular (AV) node, which can help restore normal sinus rhythm.

In the case of unstable SVT, characterized by symptoms such as hypotension, the administration is done quickly—12 mg of adenosine is given via rapid intravenous push while simultaneously flushing with 10 mL of normal saline to ensure the medication reaches the circulation quickly. This swift action is crucial for stabilizing the patient's condition and addressing the hypotension.

Other treatment methods are typically reserved for different clinical scenarios or are adjuncts rather than first-line treatments in this case. For example, continuous epinephrine infusion is more appropriate for severe bradycardia or cardiac arrest rather than person presenting with unstable SVT while remaining alert. Similarly, magnesium sulfate is not considered a primary treatment for SVT, and transcutaneous pacing is generally indicated for bradyarrhythmias or extreme situations of heart blocks rather than for SVT with hypotension. Therefore, promptly administering adenosine is the recommended and effective approach