Aa
finally saw electrophysiologist; frustrating experience
Well, after living with great angst this past month, regarding a PSVT finding on my event monitor in May, I finally saw the E.P. to whom my cardiologist referred me. Having some doubts about the diagnosis, I was hoping for some definitive answers from this expert. Instead, I was told that I "might" have "some SVT" -- or I might not. Huh?
The E.P. spoke with me for over a half hour, but was not able to tell me whether or not I experienced a PSVT, based on the EKG strip from my event monitor. I was stunned. I had great difficulty processing this. He showed me the Event Monitor EKG strip, which I examined: I could see plainly that beside the EKG were the words "sinus rhythm 182BPM". Huh? Sinus? Why was I told unequivocally by my cardiologist (in person and in repeated follow-up calls to his nurse, who re-confirmed his position) that I experienced a "re-entrant" "Paroxysmal Supraventricular Tachycardia"?
Then the E.P. confounded me further by stating that he could not make a definitive diagnosis of SVT based on the results of my 30-day event monitor results, because the Event Monitor -- unlike the Holter Monitor -- does not record the heart's activity continuously, and therefore he could not see how my 182BPM tachycardia began, only that the event monitor had captured it after it had begun. HUH? I thought the ENTIRE point of the event monitor was that it "back-recorded" several minutes, whenever an event was logged, so that this kind of information could be obtained. Otherwise, what the hell use is it? Why was I even wearing it if it cannot provide this information?
I explained to him that last month's episode of tachycardia, like all my episodes, had the non-instantaneous character of an anxiety attack with a relatively gradually increasing heart rate. He said it was indeed "possible" that my 180-200BPM tachycardias were produced by anxiety -- but that there was some doubt in his mind whether adrenaline alone could drive my heart rate that high, and that I may, after all, be experiencing "some" SVT -- or again, maybe not. (In fact, when I pressed him to give me odds, he said it was more likely -- but not resoundingly more, likely -- that I am NOT experiencing SVT).
He said he did not want to do an EP study as a first option, but instead told me to increase my dose of Atenolol slightly, drink more fluids, then see him again -- in six months.
I don't understand what happened here. He was not an unintelligent or un-credible person. I was simply expecting him to come right out and tell me Yea or Nea concerning PSVT. Instead he talked elliptically for 10 minutes about how I, as a healthy "young" person, should not worry about having a heart rate in the 180s, and that I may have some "extremely mild" form of P.O.T.S, and that I should exercise, etc.
I was thrown off my game and did not press him enough. I am extremely frustrated right now, and considering an appointment with another EP/cardio.
Sorry for long rant. Any comments are welcome.
Thanks for listening, guys.
The E.P. spoke with me for over a half hour, but was not able to tell me whether or not I experienced a PSVT, based on the EKG strip from my event monitor. I was stunned. I had great difficulty processing this. He showed me the Event Monitor EKG strip, which I examined: I could see plainly that beside the EKG were the words "sinus rhythm 182BPM". Huh? Sinus? Why was I told unequivocally by my cardiologist (in person and in repeated follow-up calls to his nurse, who re-confirmed his position) that I experienced a "re-entrant" "Paroxysmal Supraventricular Tachycardia"?
Then the E.P. confounded me further by stating that he could not make a definitive diagnosis of SVT based on the results of my 30-day event monitor results, because the Event Monitor -- unlike the Holter Monitor -- does not record the heart's activity continuously, and therefore he could not see how my 182BPM tachycardia began, only that the event monitor had captured it after it had begun. HUH? I thought the ENTIRE point of the event monitor was that it "back-recorded" several minutes, whenever an event was logged, so that this kind of information could be obtained. Otherwise, what the hell use is it? Why was I even wearing it if it cannot provide this information?
I explained to him that last month's episode of tachycardia, like all my episodes, had the non-instantaneous character of an anxiety attack with a relatively gradually increasing heart rate. He said it was indeed "possible" that my 180-200BPM tachycardias were produced by anxiety -- but that there was some doubt in his mind whether adrenaline alone could drive my heart rate that high, and that I may, after all, be experiencing "some" SVT -- or again, maybe not. (In fact, when I pressed him to give me odds, he said it was more likely -- but not resoundingly more, likely -- that I am NOT experiencing SVT).
He said he did not want to do an EP study as a first option, but instead told me to increase my dose of Atenolol slightly, drink more fluids, then see him again -- in six months.
I don't understand what happened here. He was not an unintelligent or un-credible person. I was simply expecting him to come right out and tell me Yea or Nea concerning PSVT. Instead he talked elliptically for 10 minutes about how I, as a healthy "young" person, should not worry about having a heart rate in the 180s, and that I may have some "extremely mild" form of P.O.T.S, and that I should exercise, etc.
I was thrown off my game and did not press him enough. I am extremely frustrated right now, and considering an appointment with another EP/cardio.
Sorry for long rant. Any comments are welcome.
Thanks for listening, guys.
I went to school for 21 months to be an optician. The course makes you familiar with common medical abbreviations and disorders (and a bunch of other stuff). Being at the eye doctor one day, I used the term diplopia, and the doctor stopped me, telling me not to use medical terms. I was taken aback and explained my background. He then started to speak in medical lingo well beyond my training. The net result is I came away from the examination with less information.
Being well read, being an optician and trained as a pharmacy technician, I'm familiar with many of the words and principles, but when it comes down to it, we all need to find doctors we trust and allow their well rounded education to help us through the snippets of lingo and principles we glean from each other and from our personal experiences in our struggle to understand what ails us.
Some of the information on the forum is becoming increasingly specific, unfortunately what applies to you, despite its similarities in presentation, may not apply to others. Well intended advise can become a stumbling block to appropriate care by a professional. Most of us are not going to be able to tell the center that applies the Event Monitor how to program it, an alternate approach, rather than engaging in the medical vernacular with the technicians, may be to just ask your doctor how long before the event the monitor is capable of recording and ask your doctor if he/she could provide one that better fits your needs based on your perception of events.
Best to all.
Being well read, being an optician and trained as a pharmacy technician, I'm familiar with many of the words and principles, but when it comes down to it, we all need to find doctors we trust and allow their well rounded education to help us through the snippets of lingo and principles we glean from each other and from our personal experiences in our struggle to understand what ails us.
Some of the information on the forum is becoming increasingly specific, unfortunately what applies to you, despite its similarities in presentation, may not apply to others. Well intended advise can become a stumbling block to appropriate care by a professional. Most of us are not going to be able to tell the center that applies the Event Monitor how to program it, an alternate approach, rather than engaging in the medical vernacular with the technicians, may be to just ask your doctor how long before the event the monitor is capable of recording and ask your doctor if he/she could provide one that better fits your needs based on your perception of events.
Best to all.
A typical long term monitor is set with a specific set of parameters by the clinic that provides it to you.
For instance:
My monitor was set to record when the rate changed abruptly. I ran with it, I skated with it, I had sex with it. Neither of those high rate events set it off. But I had three episodes of SVT that autotriggered it. I even pressed the button once but it was already recording. But let me go back a bit.
When the provider sets up the recorder, they set how far they want the recorder to jump back when you hit the button, or if it autorecords on its own. Mine was set to jump back one minute before the event started.
Once it began recording, it was go by the event start marker by 3 minutes. It would then stop and save the recording to one of three memory slots, with a series of short beeps. My SVT could last for days if I let it, but within 15 minutes or so, I was able to convert it to NSR. The recorder of course did nothing. So I pressed the manual record button, it jumped back one minute while I was in SVT and caught me coming out of it.
These two recordings were positive evidence of my lifelong SVT and paved the way for my EL procedure.
In closing, if someone did not set up your device correctly, it may very well have not caught the initiation of your event.
Longterm monitor tests are not cheap, but pale in comparison to an electrophysiology procedure. Mine was billed at $76,000. Armed with the information I provided you, if you do it again, make sure that it's set up correctly. Ask questions! I've found that a lot of technicians will spill their guts if you show even a spark of interest in what their doing. Throw in a little techspeak, and they'll show you everything.
For instance:
My monitor was set to record when the rate changed abruptly. I ran with it, I skated with it, I had sex with it. Neither of those high rate events set it off. But I had three episodes of SVT that autotriggered it. I even pressed the button once but it was already recording. But let me go back a bit.
When the provider sets up the recorder, they set how far they want the recorder to jump back when you hit the button, or if it autorecords on its own. Mine was set to jump back one minute before the event started.
Once it began recording, it was go by the event start marker by 3 minutes. It would then stop and save the recording to one of three memory slots, with a series of short beeps. My SVT could last for days if I let it, but within 15 minutes or so, I was able to convert it to NSR. The recorder of course did nothing. So I pressed the manual record button, it jumped back one minute while I was in SVT and caught me coming out of it.
These two recordings were positive evidence of my lifelong SVT and paved the way for my EL procedure.
In closing, if someone did not set up your device correctly, it may very well have not caught the initiation of your event.
Longterm monitor tests are not cheap, but pale in comparison to an electrophysiology procedure. Mine was billed at $76,000. Armed with the information I provided you, if you do it again, make sure that it's set up correctly. Ask questions! I've found that a lot of technicians will spill their guts if you show even a spark of interest in what their doing. Throw in a little techspeak, and they'll show you everything.
Again, I'm not going to speculate, I trust your E.P. and so should you. If you are concerned, you can get a second opinion from another E.P.
A word on cardioversion. Supra Ventricular Tachycardias, unlike Ventricular Tachycardia, can, with many patients, be stopped by Vagal Maneuvers. Vagal Maneuvers act upon the SA Node through the Parasympathetic Nervous System and can tremendously slow the heart rate. If the SA node is involved in the Tachycardia, this often aborts the fast heart rate. There are other Vagal Maneuvers done by a doctor in a hospital setting, and in limited cases in physician offices.
http://www.webmd.com/heart-disease/atrial-fibrillation/tc/vagal-maneuvers-for-a-fast-heart-rate-topic-overview
https://www.cardiosmart.org/Healthwise/ps12/83/ps1283
Hope this is of some reassurance.
As Michellepetkus said, Cardioversion is more common in A-Fib. Also, many people think of Cardioversion as the paddles, but probably more commonly is via drugs, known as Pharmacological Cardioversion.
A word on cardioversion. Supra Ventricular Tachycardias, unlike Ventricular Tachycardia, can, with many patients, be stopped by Vagal Maneuvers. Vagal Maneuvers act upon the SA Node through the Parasympathetic Nervous System and can tremendously slow the heart rate. If the SA node is involved in the Tachycardia, this often aborts the fast heart rate. There are other Vagal Maneuvers done by a doctor in a hospital setting, and in limited cases in physician offices.
http://www.webmd.com/heart-disease/atrial-fibrillation/tc/vagal-maneuvers-for-a-fast-heart-rate-topic-overview
https://www.cardiosmart.org/Healthwise/ps12/83/ps1283
Hope this is of some reassurance.
As Michellepetkus said, Cardioversion is more common in A-Fib. Also, many people think of Cardioversion as the paddles, but probably more commonly is via drugs, known as Pharmacological Cardioversion.
From my research it seemed to me that it would be very rare for someone to need cardioversion for anything other than afib which you don't have. Generally there are meds that they can give to basically rest the heart or others that simply slow it down. Generally accessory pathway svt is caused by a disruption of the heart beat, usually a pac or pvc that creates a pause allowing the extra pathway to complete and thus the loop is formed. This is why the biggest factor for accessory pathway svt is the fact it starts and stops in one beat and why it is termed psvt. Because essentially that is what happens. And it can stop in much the same way so the meds they give essentially create a situation to reset the heart and usually that is sufficient for accessory pathway svts but not so for afib which sometimes needs cardioversion to reset the heart.
And just to be clear PSVT really just means that the svt is sudden and transient or not all the time. P meaning Paroxysmal attacks or paroxysms are a sudden recurrence or intensification of symptoms, such as a spasm or seizure. These short, frequent and stereotyped symptoms can be observed in various clinical conditions. Since you have already indicated that your symptoms do not start suddenly you may not fall into this category and so any meds they give you may only need to be ones that slow the heart down, not reset it. I also suspect the fact that your rate is consistently around 200 whenever you have an episodes means it likely isn't going to go any higher. Whatever your condition that is causing your tachycardia that is where your rate sits when you have an episode. But these are good questions and ones you should ask your EP. If you feel the need by all means contact the office with these questions to get clarification before your next visit. You have a right to know.
And just to be clear PSVT really just means that the svt is sudden and transient or not all the time. P meaning Paroxysmal attacks or paroxysms are a sudden recurrence or intensification of symptoms, such as a spasm or seizure. These short, frequent and stereotyped symptoms can be observed in various clinical conditions. Since you have already indicated that your symptoms do not start suddenly you may not fall into this category and so any meds they give you may only need to be ones that slow the heart down, not reset it. I also suspect the fact that your rate is consistently around 200 whenever you have an episodes means it likely isn't going to go any higher. Whatever your condition that is causing your tachycardia that is where your rate sits when you have an episode. But these are good questions and ones you should ask your EP. If you feel the need by all means contact the office with these questions to get clarification before your next visit. You have a right to know.
thanks very much for these links, Artaud.
It seems from the discussion on the EMS site that, in general, PSVT is hard to identify with certainty, but that the presence of p-waves excludes PSVT, while 'absence of p-waves' is necessary but not sufficient for PSVT diagnosis. So maybe that is my situation: my E.P. could not tell me whether I had PSVT, based on my EKG, owing to my p-waves being not clearly identifiable on my event-monitor EKG.
I wish I had pressed him specifically about his interpretation of my event-monitor EKG. I wasn't prepared to have to draw the E.P. out on this issue. I thought he would say something less ambiguous than "maybe, maybe not."
You are right about the confusion wrought by differing opinions among different doctors as well. I was diagnosed years ago with Mitral Valve Prolapse; this year I was informed that an echocardiogram showed no such thing.
I just hate the uncertainty in all of this. It would be nice to know whether I do or do not have PSVT, because it seems to me it has the potential to be more problematic than simple high Sinus Tach (e.g., it could cause much higher rates at some point; it could require cardioversion, etc). That's not something I would want to be surprised by some day.
Thanks for your help. I hope that you get some relief from your PVCs. I have PACs sometime, and I know how annoying they are.
It seems from the discussion on the EMS site that, in general, PSVT is hard to identify with certainty, but that the presence of p-waves excludes PSVT, while 'absence of p-waves' is necessary but not sufficient for PSVT diagnosis. So maybe that is my situation: my E.P. could not tell me whether I had PSVT, based on my EKG, owing to my p-waves being not clearly identifiable on my event-monitor EKG.
I wish I had pressed him specifically about his interpretation of my event-monitor EKG. I wasn't prepared to have to draw the E.P. out on this issue. I thought he would say something less ambiguous than "maybe, maybe not."
You are right about the confusion wrought by differing opinions among different doctors as well. I was diagnosed years ago with Mitral Valve Prolapse; this year I was informed that an echocardiogram showed no such thing.
I just hate the uncertainty in all of this. It would be nice to know whether I do or do not have PSVT, because it seems to me it has the potential to be more problematic than simple high Sinus Tach (e.g., it could cause much higher rates at some point; it could require cardioversion, etc). That's not something I would want to be surprised by some day.
Thanks for your help. I hope that you get some relief from your PVCs. I have PACs sometime, and I know how annoying they are.
"The only difference between PSVT and SVT is that the onset of the PSVT can be seen as in the example above. In PATs, the origin of the rapid beats is clearly in the atria whereas in PSVTs and SVTs, a strict determination cannot be made."
http://www.equimedcorp.com/rhythms/topic/49/
""Generally speaking.....students are taught SVT (is a) tachycardia faster than 150 or 160 is "SVT".
How do we differentiate sinus tach from SVT?
That's easy: rate!
If the rate is over 150 (some use 160), then it is “SVT and not sinus tach” and should be given adenosine or cardioversion! Quickly!
(Yet) there does not seem to be any research I can find that even suggests that these numbers can be used to differentiate ST from other SVTs.
In fact, I could not find any research that demonstrates that absolute rate plays any part in differentiating ST from other SVTs.
All I could find is references to the guideline used to determine the theoretical maximum sinus tachycardia in healthy people: “220 – age”.
This “formula” is a guideline at best. It intends to illustrate that very young people can have ST at very high rates, and that as we age, it should be more difficult to achieve higher rates of sinus tach. However, we deal with really sick patients, and theoretical guidelines are not good enough to help us with this issue.""
http://www.ems12lead.com/2013/04/30/the-trouble-with-sinus-tachycardia/
As much as I appreciate the advise of various members on a multitude of issues, there are too many variables to make assertions this way or that on more complex issues. If one E.P. says my PVCs originate in the RVOT, and the next adamantly says otherwise, it's evident that years of college hasn't imbued these doctors with a Star Trek ability to run a sensor over us and instantly diagnose in all cases. If doctors have trouble, our best intended suggestions and advice may fall well clear of the mark.
Priorities should be is the rhythm stable, is it of a form likely to progress into a dangerous rhythm, is the patient coping well with a stable rhythm, and what medications can be used to lessen issues with patients coping of benign rhythm issues that are least likely to have deleterious effects on the heart's stable rhythm.
Best to all.
http://www.equimedcorp.com/rhythms/topic/49/
""Generally speaking.....students are taught SVT (is a) tachycardia faster than 150 or 160 is "SVT".
How do we differentiate sinus tach from SVT?
That's easy: rate!
If the rate is over 150 (some use 160), then it is “SVT and not sinus tach” and should be given adenosine or cardioversion! Quickly!
(Yet) there does not seem to be any research I can find that even suggests that these numbers can be used to differentiate ST from other SVTs.
In fact, I could not find any research that demonstrates that absolute rate plays any part in differentiating ST from other SVTs.
All I could find is references to the guideline used to determine the theoretical maximum sinus tachycardia in healthy people: “220 – age”.
This “formula” is a guideline at best. It intends to illustrate that very young people can have ST at very high rates, and that as we age, it should be more difficult to achieve higher rates of sinus tach. However, we deal with really sick patients, and theoretical guidelines are not good enough to help us with this issue.""
http://www.ems12lead.com/2013/04/30/the-trouble-with-sinus-tachycardia/
As much as I appreciate the advise of various members on a multitude of issues, there are too many variables to make assertions this way or that on more complex issues. If one E.P. says my PVCs originate in the RVOT, and the next adamantly says otherwise, it's evident that years of college hasn't imbued these doctors with a Star Trek ability to run a sensor over us and instantly diagnose in all cases. If doctors have trouble, our best intended suggestions and advice may fall well clear of the mark.
Priorities should be is the rhythm stable, is it of a form likely to progress into a dangerous rhythm, is the patient coping well with a stable rhythm, and what medications can be used to lessen issues with patients coping of benign rhythm issues that are least likely to have deleterious effects on the heart's stable rhythm.
Best to all.
I had avnrt and the ekg doesn't always have a tell tale sign. My wave sometimes looked like a normal wave but only fast so I am not sure that they can rule it out just by the way the wave looked. the monitor I had was manual only. It did not automatically detect anything. I just recorded constantly dumping off the end bits as it went until I told it to record. Yours apparently was programed to record if it detected an issue but you very well were already in the tachycardia before it hit the threshold in rate to start the recording. If you were already at 170 for a few minutes before it started to record at 180 we shall say then who knows when the initial start of your tachycardia was. Though it is interesting that it recorded a section at normal rate. Not sure if that was a programing thing or it detected a sudden change. You would think that would have been seen on the ekg.
If you are fairly certain that this is not anxiety related then it is possible there is something outside the heart that is causing the issue which is why you should have your thyroid checked. Your blood work should be checked yearly and they usually check your t levels which are an indication of thyroid issues. If you haven't had a blood panel done in the past year you may want to see again. there was a girl on here who was boarderline hypo and then checked just recently to be diagnosed as hyper so do have yours checked out to be sure if you haven't had it checked in the past year.
In any event, just try and do your best to not stress. Just do as much deep breathing as you can. You will get past this.
If you are fairly certain that this is not anxiety related then it is possible there is something outside the heart that is causing the issue which is why you should have your thyroid checked. Your blood work should be checked yearly and they usually check your t levels which are an indication of thyroid issues. If you haven't had a blood panel done in the past year you may want to see again. there was a girl on here who was boarderline hypo and then checked just recently to be diagnosed as hyper so do have yours checked out to be sure if you haven't had it checked in the past year.
In any event, just try and do your best to not stress. Just do as much deep breathing as you can. You will get past this.
Bromley, thank you for this clarification.
Are you talking about "Sinoatrial nodal reentrant tachycardia (SNRT)"? Interesting.
From my reading, I was under the impression that an SVT had a distinctive appearance on an EKG -- something to do with the "P-Wave" being distorted, etc.
I was under the impression that, if an episode of true SVT was recorded on an EKG, an electrophysiologist could examine the EKG and see telltale signs that pointed toward a definitive diagnosis of SVT.
But apparently this is not the case.
Are you talking about "Sinoatrial nodal reentrant tachycardia (SNRT)"? Interesting.
From my reading, I was under the impression that an SVT had a distinctive appearance on an EKG -- something to do with the "P-Wave" being distorted, etc.
I was under the impression that, if an episode of true SVT was recorded on an EKG, an electrophysiologist could examine the EKG and see telltale signs that pointed toward a definitive diagnosis of SVT.
But apparently this is not the case.
good morning, michelepetkus
>>"The event monitors do jump back in time but it is only a short amount of time"
This is unfortunate. It must literally only back-record for a few seconds, because in my case, I am using "gradual" onset to mean only over the course of a few (2-3) minutes. (Also, just to be clear, during my "SVT", the event monitor actually began recording and beeping on its own, without my pressing the "record" button, once my heart rate got high enough. I was about to hit record, but I heard the device already recording.)
Furthermore, why would the Event Monitor not be programmed to monitor the tachycardia, once it commenced, for an extended period as it progressed, in order to record the rhythm and its possible abrupt termination -- which are both potentially as important for a diagnosis of SVT as the character of its onset? When the EP showed me the EKG panels from the monitor, they seemed to show only "snapshots" of my episode, e.g., one small panel showed the 182BPM EKG, and then the next panel showed my heart rate back at 108, ten minutes later. It makes no sense that it would function this way, giving such limited information.
Still, putting all that aside: presumably, the device is designed to back-record for a length of time that is adequate to catch a typical "instantaneously" originating PSVT, since catching this is one of its intended purposes (as you say, it is ideal for this purpose). Therefore, if no "instant" onset tachycardia was detected in my case, then I assume that the event monitor demonstrated that I was instead in an escalating tachycardia, and that no instant onset tachycardia occurred, by definition. So why would he still need to see more EKG information related to onset? If the device is designed to capture the typical SVT instant-onset, and in my case did not, what does that tell the EP? I don't understand.
>>" I had heart rates in the 230s."
How long did your episodes tend to last?
>>"The more you can rule anxiety out the more clear picture you will have on whether or not there is a physical issue going on."
Yes, I see what you mean. Though I feel I have already partly established this. One reason I believe my tachycardias are likely entirely adrenaline/anxiety/autonomic related, is that for 9 years I had no anxiety attacks, and never experienced any serious tachycardia. Only, only, only during anxiety attacks do I experience violent tachycardia such as that recorded by the event monitor. I told the EP this, and I don't understand why this does/doesn't rule out SVT. I don't understand where he is seeing any indication that I have SVT -- other than the 180-200 BPM heart rate, which apparently is arguably too high to be caused by adrenaline. But then everything else points away from SVT. Was he only reluctant to tell me I did not have SVT because, as an EP, he felt he should not say so definitively without conducting an EP study? I don't know.
I wish I had tape-recorded our conversation. He spoke at length, but I am forgetting the positive/reassuring things that he said, and can only remember the uncertainties and ambiguities.
My 180BPM tachycardia/anxiety attacks are not frequent and only last 20 minutes. He seemed to be saying that I am not in danger of dying from this condition that I have, whatever it is, since my heart is healthy. I just wish he had said it more forcefully and directly. As I am trying to recall everything he said, I am becoming anxious again. And he will not see me again for 6 months.
He told me to take more atenolol if I have another of these episodes. So I guess that means he does not think I should go running off to the ER every time it happens, which means it cannot harm me, in his opinion.
I definitely should have tape-recorded our visit.
Bah. Anyway, I am just ranting. Feel free to disregard.
Thank you, michellepetkus, for sharing your knowledge with me.
>>"The event monitors do jump back in time but it is only a short amount of time"
This is unfortunate. It must literally only back-record for a few seconds, because in my case, I am using "gradual" onset to mean only over the course of a few (2-3) minutes. (Also, just to be clear, during my "SVT", the event monitor actually began recording and beeping on its own, without my pressing the "record" button, once my heart rate got high enough. I was about to hit record, but I heard the device already recording.)
Furthermore, why would the Event Monitor not be programmed to monitor the tachycardia, once it commenced, for an extended period as it progressed, in order to record the rhythm and its possible abrupt termination -- which are both potentially as important for a diagnosis of SVT as the character of its onset? When the EP showed me the EKG panels from the monitor, they seemed to show only "snapshots" of my episode, e.g., one small panel showed the 182BPM EKG, and then the next panel showed my heart rate back at 108, ten minutes later. It makes no sense that it would function this way, giving such limited information.
Still, putting all that aside: presumably, the device is designed to back-record for a length of time that is adequate to catch a typical "instantaneously" originating PSVT, since catching this is one of its intended purposes (as you say, it is ideal for this purpose). Therefore, if no "instant" onset tachycardia was detected in my case, then I assume that the event monitor demonstrated that I was instead in an escalating tachycardia, and that no instant onset tachycardia occurred, by definition. So why would he still need to see more EKG information related to onset? If the device is designed to capture the typical SVT instant-onset, and in my case did not, what does that tell the EP? I don't understand.
>>" I had heart rates in the 230s."
How long did your episodes tend to last?
>>"The more you can rule anxiety out the more clear picture you will have on whether or not there is a physical issue going on."
Yes, I see what you mean. Though I feel I have already partly established this. One reason I believe my tachycardias are likely entirely adrenaline/anxiety/autonomic related, is that for 9 years I had no anxiety attacks, and never experienced any serious tachycardia. Only, only, only during anxiety attacks do I experience violent tachycardia such as that recorded by the event monitor. I told the EP this, and I don't understand why this does/doesn't rule out SVT. I don't understand where he is seeing any indication that I have SVT -- other than the 180-200 BPM heart rate, which apparently is arguably too high to be caused by adrenaline. But then everything else points away from SVT. Was he only reluctant to tell me I did not have SVT because, as an EP, he felt he should not say so definitively without conducting an EP study? I don't know.
I wish I had tape-recorded our conversation. He spoke at length, but I am forgetting the positive/reassuring things that he said, and can only remember the uncertainties and ambiguities.
My 180BPM tachycardia/anxiety attacks are not frequent and only last 20 minutes. He seemed to be saying that I am not in danger of dying from this condition that I have, whatever it is, since my heart is healthy. I just wish he had said it more forcefully and directly. As I am trying to recall everything he said, I am becoming anxious again. And he will not see me again for 6 months.
He told me to take more atenolol if I have another of these episodes. So I guess that means he does not think I should go running off to the ER every time it happens, which means it cannot harm me, in his opinion.
I definitely should have tape-recorded our visit.
Bah. Anyway, I am just ranting. Feel free to disregard.
Thank you, michellepetkus, for sharing your knowledge with me.
OK, there are some terminology things here that can lead to confusion. Your ekg will look normal if a beat originates at the natural pacemaker of the heart and follows the normal path around the heart. If it is just anxiety or adrenaline, your pacemaker is beating fast, but the heart is responding normally and you have a fast, but normal ekg. This is not a heart issue.
If you have a re-entrant circuit near the natural pacemaker, or inside the natural pacemaker, then your heart will beat fast, but if the beat follows the normal path around the heart, the ekg will still look normal. This is a heart issue. You have a re-entrant tachycardia that stems from a problem in or near your natural pacemaker.
Either way your heart beats fast and the ekg looks normal. In one case your heart is just beating fast, while in the other you have a re-entrant tachycardia.
Im not saying this is your situation. Its possible that this is what your doctor was thinking. Yes, it is confusing.
If you have a re-entrant circuit near the natural pacemaker, or inside the natural pacemaker, then your heart will beat fast, but if the beat follows the normal path around the heart, the ekg will still look normal. This is a heart issue. You have a re-entrant tachycardia that stems from a problem in or near your natural pacemaker.
Either way your heart beats fast and the ekg looks normal. In one case your heart is just beating fast, while in the other you have a re-entrant tachycardia.
Im not saying this is your situation. Its possible that this is what your doctor was thinking. Yes, it is confusing.
I am sorry you didn't get a definitive answer. I know how frustrating that can be. The truth is arrhythmia problems are elusive and can be hard to diagnose. I had a holter my first go around and had an episode the day before not the day of and so the results were normal even though I knew they weren't. 2 years later I got an event monitor and 2 weeks in I caught an episode. The event monitors do jump back in time but it is only a short amount of time. This is still ideal for accessory pathway svts that start in one beat as a person will usually hit the button upon feeling the start of an episode and so the initiation was caught as was mine. The fact you state that you don't feel the immediate start likely indicates that the EP could not see the start of when you went into tachycardia as it occurred long before you hit the button. That said, you had a very high rate at 180 so that is why they are not ruling it out. However, EP studies are very expensive. Mine was $50,000 and that is on the low end from what I understand. So an EP is not going to prescribe one unless there is a definitive diagnosis. So you are unfortunately in the wait and see period. Your best bet is to try and work on your stress and anxiety. The more you can get a handle on it the more you will be able to separate whether or not you are simply having an anxiety attack or really have svt.
An accessory pathway svt cares not whether you are stressed or not. It simple turns on and off. I guess I was lucky enough to have had episodes my whole life so I never feared them and subsequently never got stressed about them. I had heart rates in the 230s. So very high and my heart is still fine. This said, most of my episodes were pretty short lived. If you have extended periods of high heart rates in the 180s it is best you try to see if the meds can bring it down. Did I ask if you had your thyroid levels checked? If you haven't you should definitely get them checked out. But as much as we look to doctors to have all the answers sometimes they just don't. They can only go by the information in front of them and the information from your monitor wasn't enough to diagnose you. They really need to see the telltale sign of an immediate start. So do your best to help eliminate one possible issue with the anxiety. If you notice yourself stressing try and stop and do deep breathing and maybe start to take up yoga and/or meditation. The more you can rule anxiety out the more clear picture you will have on whether or not there is a physical issue going on. Frustrating to not have the answer but sometimes we do have to do our own legwork to get to the bottom of things. Well hang in there and best of luck getting your anxiety under control. There is actually an Anxiety section here on the site. You may want to try and check it out and see if there are other pointers you can get from others who have it too.
An accessory pathway svt cares not whether you are stressed or not. It simple turns on and off. I guess I was lucky enough to have had episodes my whole life so I never feared them and subsequently never got stressed about them. I had heart rates in the 230s. So very high and my heart is still fine. This said, most of my episodes were pretty short lived. If you have extended periods of high heart rates in the 180s it is best you try to see if the meds can bring it down. Did I ask if you had your thyroid levels checked? If you haven't you should definitely get them checked out. But as much as we look to doctors to have all the answers sometimes they just don't. They can only go by the information in front of them and the information from your monitor wasn't enough to diagnose you. They really need to see the telltale sign of an immediate start. So do your best to help eliminate one possible issue with the anxiety. If you notice yourself stressing try and stop and do deep breathing and maybe start to take up yoga and/or meditation. The more you can rule anxiety out the more clear picture you will have on whether or not there is a physical issue going on. Frustrating to not have the answer but sometimes we do have to do our own legwork to get to the bottom of things. Well hang in there and best of luck getting your anxiety under control. There is actually an Anxiety section here on the site. You may want to try and check it out and see if there are other pointers you can get from others who have it too.
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