PSVT

[vinu2781]

Hi. recently i was having palpitations(no dizziness or shortness of breath).I consulted a cardiologist and echo,ECG,TMT,Holter was done. In holter a max heart rate of 158 was observed but there was no indications of psvt or vt. The Doc told i am perfectly normal and need not to worry. Again next day i had palpitations and i was forced to consult another cardiologist. He told that it is PSVT and prescribed me beta blockers. I am taking it daily. Can you kindly suggest me whether do i really have psvt as there is no observation of that in holter

[vinu2781]

Still i dont know .All my ECG, echo,tmt, blood test is normal. no BP or sugar.

[Mom2four85]

many of us have been told we have anxiety only to find out later on it's something else entirely...

I was told for years my arrhythmia's were nothing, then stress related then anxiety and panic attacks but didn't find out until I was 42 what mine were through an EP Study and ablation. At age 9 I felt my first "flutterings" and dx with psvt back in 2004 then pvc's and VT in 2009.

I do have panic attacks and anxiety but they have nothing to do with my arrhythmia's.

[tom_h]

Despite 54 years of SVT, only 3 of my episodes were ever recorded.  This happened during the wearing of a 30 day monitor.  It auto-recorded the initiation of each episode, jumping back 30 seconds before the start of it, and I manually triggered the recorder when I converted it using Valsalva, with it again jumping back 30 seconds so to catch the termination.  There it was on the recording, the start and end of each event was preceded by a PVC.  At 3-5 events per month, I had many opportunities to observe, and reflect on what was going on, and what had just happened. but  I never noticed the preceding PVC.  I suppose I was always so startled by the sudden onset that I never felt it.  As mentioned above, I would occasionally get the jumbled arrythmia before dropping into steady SVT.  But most were  off to the races.

[is_something_wrong]

Hi, there are several mechanisms behind SVT. You have the reentry phenomenon (which is by far the most common in sustained tachycardias), where a short-circuit is created, either around the AV node by different conduction time through the atrial pathways to the AV node (AVNRT) or a bypass tract between atria and ventricles (AVRT).

You can also have intra-atrial reentry causing a sustained atrial tachycardia. This follows the same phenomenon as ventricular tachycardia after a heart attack and usually is a sign of heart muscle damage, or you can be born with it.

Tachycardias may also occur by the same mechanism as PACs or PVCs often occur by, increased automaticity. If so, another focus takes over the pacemaker function and heart rate may be rapid as well. This focus responds to adrenaline and of course heart rate may elevate or decrease during the tachycardia.

The fact that you had a lot of premature beats in front of the tachycardia is common. If you had a reentry tachycardia, one of those premature beats did start it, and if you had an increased automaticity tachycardia, this spot produced a lot of premature beats until it completely took over the pacemaking function.

[vinu2781]

Thanks for the reply Even one of my cardiologist is telling that i have anxiety.

[tom_h]

The nature of the electrical anomaly in the heart that causes SVT does not support a "ramping" effect.  What you could be experiencing is the effect of a shot of adrenaline as a result of the episode.  I know when I converted mine, my pulse immediately dropped from the 200 range to perhaps 100 or so in one beat, then gradually dropped back to normal from there.  But, it was unmistakable when it dropped out of SVT.  I also have experienced the crazy run of arrhythmia as you have observed, but the initiation of it was immediate and didn't come on gradually.  With that type of initiation, I could often terminate it before it really got going by giving a sharp cough, a vagal maneuver of sorts. If that didn't work, the arrhythmia would eventually "swarm" my heart and I'd go into a steady SVT.

[Elli126]

Everyone on here seems to agree that PSVT/SVT starts and stops in a single beat. Mine seems to be a little different. I get a crazy run of "off" beats ( with what seems to be no rythym at all just thump, thumpity, thump all over the place ) that can last anywhere from a few seconds to half a minute or so Then it jumps into PSVT. Every single doc I have seen including cards have insisted it is PSVT ( last time I was in the ER it clocked in at about 300 BPM. ) then as I convert it begins to slow. As I said in another post the BBs seem to be doing ok, I'm averaging about 2 episodes yealy ( PVCs/PACs notwithstanding ) but am still looking forward to becoming insured so I can get the ablation.

[is_something_wrong]

Tom is right. Usually PSVT runs at rates 180 and up. At least those that are problematic, the so-called reentry SVT's (AVNRT and AVRT).

I'm sometimes suffering from short runs of atrial tachycardia that may run at rates as low as 80 (but that's not a tachycardia, more an ectopic atrial rhythm or line of PACs). Sometimes I sense them when I'm in bed in the morning, thinking about all work that need to be done today. My heart rate runs like:

beat------beat-----beat--beat--beat--beat--------beat------beat.

They are short and not a problem at all. I just think it's funny. Such tachycardias can also "warm up" and "cool down" but generally they are not a problem at all. Problematic SVT's will run at high heart rates and start/stop instantly.

[tom_h]

A heart rate of 158 is very slow for PSVT.  Typical rates generally range from 180 up, and beyond 250.  Children can have rates over 300.  Mine was clocked at 312 when I was 6y/o.

A important symptom of PSVT aka. SVT is the abrupt start and cessation of an event.  SVT will start and end within one beat.  It doesn't slowly ramp up and slowly end; just "blip!" and it's over. So in that regard, and I'm certainly not a physician, if your symptoms don't include this one fact, I'd look at something else.

[is_something_wrong]

Your question is impossible to answer, both for us, as lay people, and doctors. You need to ask your cardiologist who knows your test results, this question.

A normal Holter does NOT rule out arrhythmias if you didn't have symptoms of what you suspected during the 24 hours. A max heart rate of 158 can just indicate that you did some exercise or climbed some stairs..

If you haven't captured any of your tachycardia events on EKG, the diagnosis is still unclear and you should wear an event monitor or visit the emergency room when you experience the tachycardia.