PSVT - chest discomfort after episode?

[esmom]

My 14-year-old daughter was diagnosed 2 days ago with paroxysmal supraventricular tachycardia (without W-P-W). She had her first ever episode and I took her to the ER. Her pulse was 223 bpm. The doctor told her to "bear down" (vagal maneuver), which worked and brought her pulse down to a normal range. She has since been seen by a pediatric cardiologist and we have a good understanding of SVT and the fact that it is not life-threatening, and understand treatment options, etc.

My question to others with SVT: do you have some soreness in your chest after an episode? My daughter is concerned because two days after her episode she says it feels like something is "catching" in her chest, or feels like the way you feel when you have swallowed something "wrong". She seems to feel it around the area of her sternum. My theory is that either her muscles in that area are indeed sore from the trauma, or she is feeling some anxiety (who wouldn't?) and is hyper aware of her heartbeat and chest area.

All her blood tests, EKGs, and a chest x-ray checked out normal.

[esmom]

The SVT episode my daughter had on Thursday was the first one she had ever had. Luckily she was with me when it happened, and I could clearly feel and see that her pulse was not normal. It only took me about a minute to decide to take her to the ER (because of family history described below), which thankfully is only about a 5 minute drive from us. Once the triage nurses saw her pulse rate, they put her on an EKG and it recorded during the SVT, the vagal maneuver, and the return to a normal range heartrate. We are lucky in that it gave the cardiologist a very clear reading to review, which does help ease my mind a bit. I think her episode might have lasted a total of 20-30 minutes.

Complicating our emotional response to all this is the fact that my niece collapsed two years ago at the age of 18 from sudden cardiac arrest and died two days later. The definite cause of death was never established, but the doctors are pretty sure she had Long QT syndrome. Her younger brother (who is 14 and a very close cousin/friend of my daughter) has undergone extensive testing, was put on beta blockers for a while, and has finally been cleared through genetic testing. The cardiologist my daughter is seeing is the same one my nephew has been seeing, so she is familiar with the family history. She also regularly consults with an electrophysiologist at Duke who has been involved in our family case.

This cardiologist is also already familiar with my daughter because shortly after my niece's death, my daughter fainted at school. Her pediatrician, after hearing about my niece, requested that we get a full cardiac work up to make sure this was only a simple faint. At that time, the cardiologist did a resting EKG, a stress test, and had my daughter wear a 24 hour holter monitor. She found nothing out of the ordinary, and confirmed that it was just a simple faint.

The cardiologist has reassured us that there is no correlation between SVT and Long QT Syndrome.

Oakbucket -- The pediatric cardiologist did offer to put my daughter on beta blockers but we had decided to just wait and see how she does. She is an athlete - last season playing school soccer, travel soccer and rec lacrosse - and we hesitated to try the beta-blockers for fear they would drag her down. When my nephew was on them, they definitely slowed him down.

Right now my daughter is away at soccer camp, and it is a challenge for her. This is the first time she has really worked out since the SVT episode last week, and she is having trouble not knowing how to read her heart. She says that when she sprints and her heartrate rises, she thinks the SVT is starting again, so she slows down, and her teammates don't understand what's going on. I told her I think the more she continues to play soccer, the better she will get at determining what is a normal rate increase and what is SVT. I told her to make sure to tell her coaches what's going on, and to tell a friend or two. (She doesn't want to be a "drama queen" and announce her condition to everyone.)

Anacyde, what you told me about the PACs seems to make a lot of sense. But I just spoke with the cardiologist today, and described my daughter's chest discomfort. She reminded me that my daughter's EKG showed a very normal healthy heart. She and the ER doc did not see or hear PACs after the episode. She feels that the chest pain is chest wall pain, most likely from anxiety, and possibly even some reflux caused by the anxiety. She feels that my daughter's worry about her own heart is probably exacerbated by losing her cousin to cardiac arrest. The doctor thinks it's good for my daughter to be at soccer camp, but that it may take a couple of days of playing for her to adjust to being back in the game. She offered for my daughter to call her directly if she feels she needs more reassurance. I'd say just knowing that will help my daughter relax a little bit.

Oakbucket -- the other treatment possibility our cardiologist offered is radiofrequency oblation, which would in effect "freeze" the faulty electrical site. This should eradicate the SVT. She thinks this is an excellent option for my daughter because it would also give the electrophysiologist an opportunity to investigate her "electrical map" and thoroughly check things out, hopefully alleviating fears we have about whether or not my daughter may also have a potentially fatal arrythmia like my niece's.

Right now we are taking a wait-and-see approach to treatment. If the SVT episodes are frequent, we may decide to try the beta blockers. My daughter has already voted for the ablation. She wants this thing gone! But we're not rushing in to anything.

Thanks for the input and support from both of you.

[oatbucket]

Hi:

Welcome to this forum.  My 12 year old daughter was recently diagnosed with AVNRT which I guess is sort of the same thing as your daughter.  She had been having rapid heartbeats off and on for a couple of years but everyone kept saying that it was just anxiety or because of the fact that she is so thin etc, etc.  Finally she was put on an event moniter and it was then that a rapid (250 bpm) was captured.  She also went to a Pediatric Cardiologist and he too told her that even though it's scary, it's not life threatening.  While that makes her (and me!) feel a little better, it still is very scary to both of us.  She has had episodes since her diagnosis about 2 months ago.  They seem to happen mostly when she's riding her horse.  In answer to your question, my daughter almost daily, says that her chest hurts.  For her I think it's anxiety related (since her diagnosis she has become much more anxious just waiting for an "episode").  We've been told that anxiety can bring on an episode and we've also been told to get rid of the anxiety and if she could, she would.  How long did your daughter's episode last?  What else did the Pediatric Cardiologist tell you?  I can't tell you how "thrilled" I was to read a post from another mom who's DAUGHTER is going through this (young daughter).  I have a friend (I'm 45) who has SVT and she is a big help but I think it's better to know of a younger girl who is going through this.  Maybe we can compare notes and help each other.  This is so new to me and my daughter and any encouragement we can get/give would really help us.  Did the doctor mention beta blockers?  Is your daughter going to go on them?  My daughter doesn't want to quite yet (she doesn't like taking any meds at all, not even Motrin) the doctor said she didn't have to go on them unless this "thing" was affecting her quality of life and so far it hasn't really.  Anyway, enough from me.

Thanks!

Carla

[anacyde]

Hi there.  I am 29 and was diagnosed at 16, so I understand very much how your daughter feels right now.  I became very hyper-aware of my heartbeat and it took me years to come to terms with, accept and be comfortable with my SVT episodes.  I can't say I'm 100% okay with them by any stretch, but time helps.

Anyhow, to answer your question, yes I've had that sensation and short SVT runs and atrial extra beats feel exactly like you describe.  It's not pain, it's not unbearable, but it is unpleasant.  My guess would be she is having either short little runs or just PACs (premature atrial contractions) which are benign and everyone has them.  PACs can happen more frequently in people with SVT.  Sometimes after a particularly bad SVT day I will have more PACs than usual - her heart may be irritable from having just done through the episode that got her diagnosed.

Something to consider being that she is female is her hormones.  At ovulation and at period time, many of us with palpitations or SVT will have an increase in symptoms.

I hope she feels better soon.  She may find symptom improvement as she gets older.  It's not terribly uncommon in children and adolescents.  My best advice for her, from someone who has been there, is don't let fear take over.