Facial Cold Stimuli to Treat Supraventricular Tachycardia at Makasar Subdistrict Primary Health Care, Jakarta, Indonesia : A Case Report

Author : Aisyah, E. A. Pratama, S. Nurwulan
Upload Date : 19-04-2018

Introduction: Supraventricular tachycardia (SVT) is a common cardiac arrhythmia in the emergency setting with prevalence in the general population is 2.25 per 1.000 persons and a two-fold risk in female. Facial cold stimuli is another type of vagal manoeuvres that increase vagal tone and results bradycardia response to terminate SVT.

Objective: This is a preliminary study to prove that facial cold stimuli is effective to treat SVT AVNRT in primary health care.

Case Illustration: A 46-year-old woman, without history of congestive heart disease, complains palpitation and chest discomfort in 1.5 hours. At the admission, blood pressure was 130/70 mmHg, heart rate 150 beats/min with regular rhytm, without cardiac murmur, and BMI 31.21 kg/m2 (obesity). Electrocardiography revealed SVT with 157 beats/min. There was no response to carotid massage. Then, we applied an ice cube on her cheek and palpebral without breath hold and pressure on the eyeball for 10 second. At the first minute, sinus rhytm followed with Non-Sustained Ventricular Tachychardia and became into PVC. The PVC slowly diminished and completely convert into sinus rhytm after 15 minutes with heart rate 105 beats/min, without loss of consiousness and hypotension.

Discussion: Facial cold stimuli creates physiological response similar to Dive Reflex (DR). DR could be considered as peripheral a sub-form of the Trigeminocardiac Reflex (TCR). In American Heart Association 2015 guideline, applying an ice-cold wet towel to the face or doing facial immersion in water at 10oC has proved effective for terminating tachycardia. However, Smith et al, in his meta-analysis, there is no standardize method for DR.

Conclusion: Facial cold stimuli is easy, effective, and non-invasive treatment for terminating SVT. A further research about this procedure is needed so it can be used as an option to treat SVT in primary health care.

KEYWORDS : Supraventricular Tachycardia, Diving Reflex, Trigeminocardiac Reflex

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