The most likely rhythm diagnosis is...
EKG shows a Regular Narrow complex Tachycardia(NCT), normal axis. Occassional retrograde upright P waves in V1, V5,V6; Short RP Interval(<90ms), no QRS alternans - likely AVNRT > AVRT NCT suggest supraventricular rythm - SAN, Atrium, AVN, Bypass tract, rarely fascicles. Short RP interval suggest atrial activation immediately after ventricular activation prioritising re-entry arrythmias like AVNRT, AVRT(Accessory pathway) & rarely atrial tachycardia
🧪 What are you concerned about? What initial maneuver can be tried bedside before giving medications?
Hemodynamic instability, heart failure are considerations prior to further management. Termination of rhythm with Vagal maneuvres or adenosine can be attempted. Recent REVERT Trial( Lancet 2015) showed modified Valsalva triples success of cardioversion compared to standard technique (43 vs 17%)
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