Sinus Tachycardia or SVT? How Paramedics Can Tell in Seconds | Class Professional

A regular narrow-complex tachycardia at 180 bpm: sinus tachycardia or SVT? We break down the clinical and ECG features that help paramedics distinguish a compensatory sinus tachycardia from a true re-entry rhythm without relying on heart rate alone. The episode begins with a 34-year-old experiencing sudden palpitations and a regular narrow-complex tachycardia at approximately 180 bpm. From there, we work through the findings that can change the differential: • Sudden versus gradual onset • Clinical context and underlying causes • Patient appearance and perfusion • Rate and rhythm regularity • Respiratory variation • P-wave morphology and placement • SVT, atrial flutter and atrial fibrillation • Stable versus unstable presentations TIMESTAMPS 00:00 SVT case introduction 01:02 Assessing sudden-onset tachycardia 03:21 Reading the ECG: narrow-complex rhythms 04:30 Sinus tachycardia vs. SVT 07:19 AVNRT and re-entry pathways 08:57 What “supraventricular” really means 10:08 SVT triggers and patient history 11:13 Stable vs. unstable tachycardia 12:55 Why SVT can impair cardiac output 14:34 A practical ECG learning resource 17:16 Vagal manoeuvres and the modified Valsalva 20:04 When to establish IV access 21:21 Adenosine: how it works and how to give it 23:29 Preparing patients for adenosine 25:02 Adenosine dosing and contraindications 27:21 Managing borderline blood pressure 30:11 Sedation and cardioversion 31:15 Wolff-Parkinson-White explained 32:57 Atrial fibrillation with WPW: key risks 35:17 Assessing accessory-pathway risk 35:53 Closing notes and disclaimer MATERIAL FEATURED IN THIS EPISODE The ECG concepts and case-based learning featured in this episode are supported by Clinical ECGs in Paramedic Practice, published by Class Professional. This concise, full-colour guide takes paramedics from cardiac electrophysiology and foundational rhythm recognition through systematic 12-lead ECG interpretation. It combines practical explanations, clinical cases and more than 100 practice ECGs to strengthen interpretation, clinical reasoning and decision-making. Explore Clinical ECGs in Paramedic Practice: https://www.classprofessional.co.uk/books-ebooks/paramedic-emergency-care/paramedic-textbooks/clinical-ecgs-in-paramedic-practice/ Explore Class Professional’s clinical education resources: https://www.classprofessional.co.uk/ Class Professional Canada: https://www.classprofessional.ca/ SPONSORED BY CLASS PROFESSIONAL This episode is proudly sponsored by Class Professional, creators of trusted, evidence-informed books, digital tools and educational resources for paramedics and healthcare professionals. Listen to their podcasts and author conversations: https://www.classprofessional.co.uk/podcasts/ FOLLOW CLASS PROFESSIONAL Instagram: https://www.instagram.com/classprofessional/ Canadian Instagram: https://www.instagram.com/classprofessional\_canada/ YouTube: https://www.youtube.com/@class.professional LinkedIn: https://www.linkedin.com/company/class-professional/ Facebook: https://www.facebook.com/ClassProfessionalPublishing/ X: https://x.com/classprofession Threads: https://www.threads.net/@classprofessional ABOUT THE INFLECTION POINT The Inflection Point explores the decisions, systems and human factors shaping healthcare, paramedicine, leadership and patient safety. IMAGE CREDITS All ECG images, rhythm strips and medical illustrations of the heart featured in this episode are reproduced from Clinical ECGs in Paramedic Practice with permission from Class Professional. DISCLAIMER This content is intended for education only. Always follow current evidence, local medical directives, organizational policies and best-practice guidelines. #SVT #SinusTachycardia #ECG #ECGInterpretation #Paramedic #Paramedicine #Adenosine #Cardiology #EmergencyMedicine #ClassProfessional @class.professional