Recognizing supraventricular tachyarrhythmias in female patients: beyond palpitations to symptoms like anxiety, panic, and nausea

Study objective: To investigate sex-specific differences in the clinical presentation of Supraventricular Tachycardia (SVT) in patients presenting to a tertiary care Emergency Department (ED) and to examine whether sex-related differences in management and follow-up are observed in our cohort. Methods: We conducted a retrospective cohort study of adults presenting with palpitations and diagnosed with SVT at a tertiary care ED in 2019. Diagnoses were confirmed by electrocardiogram review. The prima-ry outcome was sex-specific differences in symptom presentation. Secondary outcomes included differences in acute treatment, treatment success, follow-up recommendations and etiologic factors. Multivariable regression analyses adjusted for age, Charlson Comorbidity Index, and prior SVT treat-ment were performed. Results: Of 375 screened patients, 278 were included (45.3% women; mean age 49.5 years (SD 19) of all pa-tients). Women had a significantly higher prevalence of hypokalaemia (11.1% vs 3.3%; adjusted odds ratio [OR] 3.7 (95% CI 1.3-10.9, p=0.018)) and reported more overall symptoms (adjusted difference 0.3, 95% CI 0.03 - 0.56, p=0.027). Leading symptoms such as palpitations (OR 3.5 (95% CI 1.3-9.0, p=0.011)), nausea (OR 2.2 (95% CI 1.1-4.5, p=0.026)), and anxiety (OR 2.9 (95% CI 1.1-8.1, p=0.031)) were more frequent in women when presenting in the ED. Atrial fibrillation was the most common di-agnosis in both sexes without any significant sex-related difference in the frequency. Atrioventricular nodal reentry tachycardia was more frequent in women (12.7% vs. 5.9%, OR 2.4 (95% CI 1.01-5.8, p=0.047)), whereas atrial flutter was significantly less common in women (3.2% vs. 11.2%, OR 0.2 (95% CI 0.07-0.7, p=0.011)). No significant sex differences were observed in acute treatment, treat-ment success or follow-up. Conclusion: Women with SVT present with a higher symptom burden and a distinct symptom profile. Clinicians should maintain a high index of suspicion and ensure electrocardiographic evaluation in all patients with compatible symptoms regardless of sex, but particularly in women presenting with palpitations, nausea, or anxiety.