SVT or just a Panic Attack?

[crazycam]

Hello,

I am needing some help. I recently have been having these episodes where my heart will will sky rocket, it feels like its up to 200, chest feels like it will explode. These episodes last between 10-15 mintures. Now I can tell you when I feel my pulse shoot up, yes I am panicing, who wouldn't?? But I have been seen by 2 Cardiologists, one of them during my stress test, I had this happen and my pulse was 180 before I got on the treadmill. This led him to think I might have SVT. So he sent me to an electrophysiologists, he ran tests, monitored me for 30 days. However I never had one of these episodes during the monitoring period. I just had this last night. I was standing in my bathroom about to do my business, when I heard a knocking sound in my chest, from heart was tapping on my chest wall which I have not heard before, then I felt this sensitivity in my chest area and my heat began to sky rocket. It felt much like it did that time it was registered at 180, almost faster, and I was sitting down! My question, sorry for the rant. Could I have PSVT, or this is this common for panic attacks? Should my pulse go to nearly 200 during a panic attack? I find that hard to believe. Is it safe for my rate to be this high? Again it stays that high for about 10-15 minutes until my breathing finally calms it down. Thanks.

[MichelleP_3811]

It sounds like svt possibly triggered by some pacs or pvcs.  In general organic svt will start and stop suddenly for what seems to be no apparent reason.  The fact that you calm your breathing down may exclude the organic (accessory pathway) kind but only a doctor can determine that for sure.  Until you are able to get this caught and recorded though you may not know for sure.  Obviously you would need to have the episodes at least once a month.  If it isn't organic svt then it could be stress tachycarcia triggered by your body reacting to the knocking sound you felt in your chest.  Essentially anxiety triggered by your palpitations.  This is common as well.  You, however, do not need to panic.  I grew up with svt and maybe because I have had episodes since I was young I never got worked up over them.  As you have experienced, they do stop.  If you can't get it to stop within a half hour or so then call an ambulance and maybe they or the ER can catch it for you but again, if it stops on its own and is normal when you get to the ER you will just be told it is anxiety.  But rest assured, your heart is an amazingly resilient muscle that can handle a lot.  Like I said, I have had episodes my whole life (in my 40s now) even some long ones until I recently had my svt ablated last Sept and my heart is still healthy as a horse so you will live a long and healthy life but keep on top of whatever is going on.  At some point if it is an accessory pathway svt it will mature enough for you to get it corrected permanantly through ablation.  But please, try to not panic, sit down when it happens and take some deep breaths or try holding your breath and bearing down as if going to the bathroom and you may be able to get it to stop that way.  Take care and keep us posted on how you are doing.

[crazycam]

Thanks you. I called my cardiologist office and told them whats going on. The Cardiologist wants me to come back in for longer monitoring. I can tell you I do get it about once a month. Sometimes more than once a month. Thank you for your response, as I am freaked out and feel like I'm dying because of this. When my heart rate goes that fast, and it wont slow down, it just scares me so much. Thank you.

[MichelleP_3811]

Don't be scared.  You will live through this just fine.  It feels more like a bigger deal than it is so release the fear.  We are here if you need to talk.

[tom_h]

Like Michelle said, SVT starts and stops abruptly, within one beat. There's no ramping up and down, no gradual increas or decrease.  When you drop out of SVT, your pulse may be elevated, but that's usually due to anxiety from the event.  Most prople feel the initiation as well as the termination of SVT, it's unmistakable.  DO NOT CONFUSE SVT WITH ANXIETY!  Be careful mentioning the two at the same time to your physician.You don't want to be misdiagnosed and/or mismedicated.  Measure your pulse rather than guess.  SVT will almost alwatys be 180 and higher, much higher.  I seriously doubt whether anxiety alone is capable of pulse rates exceeding 200.  AN EKG will almost always show a "normal heart", so quite often, a physician will assume you were having a panic attack or severe anxiety.  You will need to capture an event so the physician can see the SVT.  To do this you will either need a 30 day monitor, or get to an ER as soon as one starts so they can hook you up to an EKG.  If you think you're having SVT and not anxiety, you must be proactive in order to get treatment.  Write the events down, dates, time, length, what you were doing, rate, etc.  This will be of great help to the physician, and will put you on the right treatment course.  Anxiety medication dials you wayyyy back.  My wife was on it for years.  You don't want to be on something like Alprazolam (Xanax) if you don't need it.  Good luck.

[crazycam]

So you are saying SVT happens within one beat instantly? Cause mine did gradually increase, I think... It went from normal to really fast within like 5 seconds. I was standing in my bathroom, I heard that knocking sound in my chest, I checked my pulse and it started getting faster. I knew immediately I was having an episode (Panic attack/SVT?). I sat down in my room, and my pulse just began to get faster and pound really hard. I tried to check how fast, but it was to fast for me to count since I was already panicing. I just dont know. I'll talk to my cardio next wednesday and update you all.

[MichelleP_3811]

It will start and stop suddenly though during an episode it can change rates but by a smaller percent.  Basically I would go from 90bpm to 220 and fluctuate between 210 and 230 and then it would stop suddenly and go back down to 100ish and fluctuate there by 10 to 20 beats all fluctuations based on whether I was sitting or standing and walking.  But yes, it takes off like a race horse out of the gate in an instant and stops the rapid beat just as suddenly.  So figure a 100bpm difference either way all at once.  If you slowly go up from 90 to 190 then it is more likely anxiety.  But the switch is obvious.

[tom_h]

SVT will start instantly from within one beat.  Sotimes it will begin as a fluttery feeling.  Once it starts it goes as the same speed.  It doesn't gradually get faster or slower.  When one begins, stop for a moment and take note of what it's doing, how it starts up.  Try not to panic.

[crazycam]

Ya, it wouldn't stop instantly. It took a few mins to slow it back down, also my rhythm was normal. Is SVT and Wolff-Parkinson White syndrome the same?? I never had any of these isses 6 months ago. It wasn't until I had this happen after trying weed for the first time. Ever since I get repeat ones every month or so. I am anxious daily though.

[MichelleP_3811]

WPW is a type of SVT but it is one you are born with so you likely would have experienced symptoms prior.  It also has a pretty distinct look on the ekg so I think one of the cardiologists would have spotted it during your treadmill test since you stated you had it then.  SVT generally presents as a normal rhythm but just really fast.  That said, it usually doesn't ramp up or down so I am not sure what your issue is.  There may be some other issue with the heart that is causing it to speed up that I am not familiar with.  Well keep an eye on it and take Toms advice and keep a diary and then go back to the doctor again to see if you can catch it at a future date.  But in the absence of shortness or breath or passing out whatever is going on is likely nothing to be too concerned about.  Our hearts are pretty resilient.  Take care.

[crazycam]

Maybe they are just panic attacks. I have spoken to others with panic disorder and they stated their pulses can go above 200 during a bad one.

[tom_h]

Anything is possible I guess.  My wife had really bad panic attacks.  When she told me her heart was racing, I'd measure it and it was always below 150.  Her definition of "racing" was a lot different than mine!  I've gotten my sinus heart rate over 200 on occasions, but it was all out, pedal to the metal, full smoke physical activity.  It is extremely difficult to reach those rates. My "resting" SVT rate in later years was around 200.  To feel that rate at normal respiration is both interesting and frightning at the same time.  It's amazingly fast, and seemingly impossible for a muscle to cycle that fast in rhythm.  So, I'm only suggesting that perhaps folks who report heart rates of 200 during a panic attack are blurring the line between anxiety and SVT.  Believe me, I had it for 54 years, and each episode of SVT was wrought with anxiety!  None of them were fun, and all I wanted was for them to end.

[crazycam]

Well I had a panic attack during a stress test. Right before I got in the treadmill, I was only standing, and my pulse had already reached 180. They nurse was shocked, but she looked at the EKG and was like "Look's good though". So I don't know. I wasn't able to check it at the time of the attack, alll I know is it felt insanely fast. I guess that's the panic though. Could be decieving how fast it really is.

[MichelleP_3811]

Yeah, I am with Tom it seems kind of fast.  Did the cardiolgist not look at the ekg that was issued on the day of the stress test?  It may be he wants to see how it starts as opposed to how fast it is going because a fast heart beat looks the same on the ekg as an accessory pathway svt.  I think it is good you are going to get the longer monitor especially since you state it happens at least once a month.  A good loop recorder should do the trick.  When you have an episode you will hit a record button and then phone in the reading.  At that point the cardiologist will see what your heart is doing before the episode starts and should be able to determine from there what type of tachycardia you have.  If you do indeed have an accessory pathway svt they can offer you an ablation to correct the problem for good.  If it turns out it is stress then you will likely be offered medication to help alleviate the symptoms.  

[crazycam]

He did. He thought I might have SVT but wasn't certain because he is not an electrophysiologist. So he sent to one. That guy gave me a 30 day holter, but I never had one of these attacks when I was using it. I called him and will see him on Wednesday. Should I ask for another 30 day holter until I am able to record one of these events?

[crazycam]

Also the elctrophysiologist having doing a 24 hour holter, 30 day holter said it looked perfectly fine. I mean if I had SVT wouldn't it have shown up somewhere, or only when I have an episode?

[tom_h]

WPW has a telltale marker.  But most SVT's are concealed. An EKG in sinus rhythm will show nothing.

[MichelleP_3811]

If you did not have an episode when you were wearing the monitor then no the issue has not been documented.  Hopefully a new 30 day monitor will garner better results for you.  As much as you want to avoid the episodes you will want to have one while wearing it so you can get a diagnosis.  Good luck.

[Volynicks117]

I have these same episodes, and get really scared as well.  I don't want to turn this into a therapy outlet for me, but I can completely relate to what you're going through.  It's so unpredictable, and scary.  In the past it's been confused with anxiety and stress related, and it just makes me feel crazy.  Looking back it's been going on for 15 years, on and off.  My electrophysiologist told me there are two treatment paths, ablation or medicine forever.  Being a young female, who has played volleyball year round since I was 9, with a young daughter and wanting to have more children, masking the symptoms with a pill from here on out isn't appealing.  I am concerned though that maybe this isn't SVT.  I have chest pains, racing heart, skipped beats, shortness of breath and occassional minor stomach pains.  I feel as if my heart is going to pop out of my chest. I had a stress test which triggered an episode.  I've worn a halter monitor twice in the past 10 years, 48 hour ones, which did not catch anything.  I'm not sure what else it could be though.  Any suggestions/ideas?

[tom_h]

Have you considered a 30 day monitor, or perhaps an implanted monitor for long term monitoring?

[crazycam]

Just giving an update. It's been two years, and I am still having these episodes. I have seen my fair share of cardiologists over this time. I finally got one of these events recorded on a holter. They said it did get up to 180, however it was purely sinus tachycardia. The electrophysiologist did not seemed concerned at all and has referred me to a pyschiatrists to control these panic attacks. So I am here to say that yes, in some people like me who are young (24), if your heart is healthy enough, a panic attack can and will send your bpm to 180+. Thanks for everyones input!

[atljunie]

I agree with this comment.  All I have to do is see an ECG machine and I'm off to the races.  I went to the ER once just to be safe with random ectopic beats.  They hooked me up to ECG and - bam - 160.  I had been in the low 90s for the previous two days (even that was high).  That led to Adenosine, which my heart blew through like was nothing.  Lorazepam got me down to 120.  Lopressor got me down to 90.  Getting me the hell out of the hospital got me down to 72.  When these ER docs say they "don't see" 160 with panic attacks, I wonder what the hell they're talking about. I think the ER docs, cardios, and pychs need to get together on this one.  Glad you've got a cardio who seems to get it.

[guinea54]

  i hope someone reads this. I am in a similar boat, and not sure what to think or do.  Here are my symptoms. its been happening only to me right when im trying to sleep.. all of the sudden i will feel like gas or something.. i can't explain it.. ill feel a little bloated .. and than ill start feeling a nervous feeling i can't control... ill start sweating. my heart speeds up, than it goes into like a drum beat really fast mode.. soon as that happens lately for some reason i calm myself down pretty fast.. and than the really fast heart rate stops.. im not sure if it it stops suddenly or not..  i guess my main question is.. can you feel SVT coming on before it goes into the super race mode? i don't think it happens with me where im laying there fine. and than my heart starts pounding away immediately.. i feel something coming on, start sweating.. and it is like an escalating feeling.. and If i can't fight it.. it jumps into a super fast heart rate that seems abnormal..  sometimes I feel like I have the ability to control whether or not it turns into the fast heart rate.. but once it kicks into gear its like a machine ... doesn't last very long.. maybe 10 seconds, to 1 minute

[trus75]

guinea54, it really sounds like a panic attack. I've had some similar episodes, anxiety about hear rate, then it gets faster, faster, faster.... Mine was 188 when I could measure it, but I'm pretty sure it went near 200 at some point. But after 2-3 minutes it goes back to the 120 -130 zone. Sometimes it goes back to the normal rate just after one hour or so, but If I have a strong attack, I can have HRs of 100+ for many hours before my heart slows down. In My case, I'm pretty sure that I haven't had anything else but panic attacks, trigged by PVCs or some bad thoughts.

[tom_h]

Your descriptions of what you're feeling are open to a lot of interpretation. The terms "really fast", "drum beat mode", "super fast", etc.  mean different things to different people.  Please take the time to ready my post at the top of this page.  Is gives a description of what SVT feels like.  Yo need to measure your pulse to establish just how fast it's really beating.  As I noted in a post above.  listening to my wife's "really fast" heart beat during a panic attack, I was surprised to note that it was about half of what my "really fast" heart rate was.  There is typically no precursor to an SVT event; no warning.  It just happens.  You don't get a "funny feeling" prior to having one.  As I've said before, a 30 day, long term monitor offers an extended opportunity to capture what your feeling whereas a 24hr, Holter monitor capture only a tiny slice of your everyday life.  If you read through these posts entirely, you'll understand what SVT feels like, and how to deal with it.