What Kind of PSVT do I Have?

[Jim_in_WA_state]

What can anybody tell me about my own special brand of PSVT?  I am a 76 year old male, generally fit and healthy, who started having PSVT two years ago.  I have a major episode every three months or so and brief flurries several times a month.  A major episode might last 6 hours or more.  A minor one lasts less than a minute.    The heart rate is usually 155 to 180 as measured by my exercise watch or my blood pressure machine.  I used to feel faint, but I think that might just have been a panic attack on top of the PSVT.  I no longer feel faint when having PSVT and there are no other symptoms, such as chest pain.  There are two things that make me think my case is unusual.  First, exercise helps and vigorous exercise cures.  When I get an episode I feel better if I go for a vigorous walk.  If I find some stairs and run up them until an appropriate heart rate approaches what I'm experiencing, it cures the problem.  When I stop running up the stairs, my heart rate quickly goes back to normal and I feel fine.  The second thing that seems unusual is that I was treated with adenosine during a major episode.  The paramedics gave it to me twice (I believe 6 mg each time) and the Emergency Room doctor gave it to me two more times (I believe 6 mg and then 12 mg) --  a total of four times during one episode.  Adenosine stopped my heart briefly, except for a little blip, but the rapid heart beat immediately returned.  Others praise adenosine; it did no good at all for me.  I am now taking Diltiazem (120 mg), and I don't think it is working.  I had an episode recently which was long enough for me to cure it with the running-up-stairs routine.  I have an appointment with a cardio- electrophysiologist in January 2015.  He has already told my doctor an ablation will fix my problem.  I need to know the questions to ask and, before I undergo surgery, I want to get a second opinion.  Thanks for any help, answers, or observations you might care to make.  

[tom_h]

Well, we're always happy to offer help, Jim.  I'm glad that they have pinpointed what it is.

It's very possible that running up steps does a number of things that could help in conversion.  The bouncing movement could be involved, as well as the cyclical tensing and relaxing of the abdominal muscles as you bound up the steps. Until I got mine fixed at 60, I would initiate SVT sometimes if I landed flatfooted off a curb, or if I twisted my torso like when getting out of a car.  There were all kinds of repeatable movements that would do it on occasion.

I'm sure that your son is looking out for your best interests.  Keep in mind that there is no actual "cutting" involved.  I'm sure his definition of "surgery" might be all encompassing.  They actually get into you leg by means of a large needle of sorts, so it more of a puncture, than a cut.  For me, by day three I had nothing more than a red dot at the top of each leg.  I had it done on a Thursday, took it easy on Friday, and was literally back at it, albeit slower than usual by Saturday.  I went back to work on Tuesday, and drove my wife and I 250 miles to celebrate Thanksgiving with our children two days after that.  So the recovery time is very quick. I did feel off a little for about a month afterwards.  Though 8 days after the procedure, I had my skates on with my son pacing me to keep the speed down to just warm-up laps.  I think if you're in good shape, you'll bounce back quickly.  Good luck, Jim!

[Jim_in_WA_state]

Dear Tom,

Thanks again for responding.  I have to feel blessed when I consider that you have had to deal with this problem since age 6, and mine didn't start until age 74.  I really sympathize with you and the other people on this forum.  I am feeling kind of foolish about all the attention and expense I'm demanding or getting involuntarily, so it helps with my feelings of guilt to talk to others with the same problem.

Yes, I tried all the usual ways of getting my heart rate back to normal -- bearing down, ice water on the face, etc--, but running up stairs is the only thing that works.  For the first few episodes I had no idea what was happening, and neither did my doctor.  I thought at first it was dehydration.  My doctor did all kinds of tests, including the Holter monitor.  He eventually settled on the possibility that it was PSVT, but I could never get to a place where I could get an EKG in time to know for sure.  When I finally did I regretted it.  The ER couldn't get me back to normal and they put me in the hospital overnight.  Shortly after that decision my heart rate went back to normal.  They had me on Diltiazem, but I think the episode had just run its course.  The night nurse decided to take me off Diltiazem when my blood pressure was down to 80/40.  Now I'm taking Diltiazem pills and worry about low blood pressure, although I am measuring it regularly and most of the readings aren't too worrisome.  I want a catheter ablation to get rid of this problem altogether, but my son says to be cautious about getting into surgery.  He doesn't know anything about heart problems.  He does liver resections.  He thinks I should just take pills for the rest of my life.  I'm planning to live another 20 years.  

Cardioversion has not been tried.  Doing handstands doesn't sound like a bad idea.  It's nice to know that somebody else has an unusual approach like me.  I tried running in place, push ups, and bicycle exercises, but running up stairs is the only thing that works.  I have not been living with the problem very long, and didn't even have an idea of what it even was until fairly recently.  I woke up with it last summer in a hotel, so I got dressed and headed for the stairs, but it stopped before I got there.  

[tom_h]

I have no idea, Jim why exercise converts your SVT  Perhaps you're inadvertently causing some abrupt pressure change within your body that causes conversion back to NSR.  Have you tried the usual methods to convert; face in a pan of ice water, or holding your breath and squeezing down?  There was a young woman on here a couple of years ago that converted by doing a hand-stand against a wall.  Have they tried synchronized cardioversion?

[Jim_in_WA_state]

Dear Tom,

Thanks for your answer.  I am thinking ablation is the way to go, but I have yet to convince my son, who is a surgeon, that I should take the chance.  The only thing is that my case seems so unusual.  Why does exercise fix the problem?  Why does nothing else work, including adenosine?  

[tom_h]

Jim, I can say without a doubt that very few of us get conversion by increasing our respiration rate.  I'm 12 years younger than you, by my cardiologist was vey concerned over the high rates I was clocking during my SVT events.  I was regularly at 220bpm, and if I was exerting myself could be as high as 240 to 250bpm.  He told me that rate was just too high for an "old guy", and strongly recommended that I talk about an ablation.  I had the lifelong ability to be able slow it myself with valsalva, so I had it it under control without taking medication until about 5 years prior to getting it fixed.

Jim, based on what my doctor told me, I'd be very concerned about overstressing your aging heart.  Like you, I was and still am in really good shape for a "old guy" and still regularly work out, coach, and compete.  But SVT really sends the rate up way beyond what I experience doing those things so I had the ablation done, and it gave me a normal life for the first time since I was 6 years old.

I highly recommend the procedure.  It isn't a big deal, but there are risk  just like any other hospital procedure.  But based on your age, and number of episodes that you're experiencing, I think that it's worth the relatively low chances of an emergency occurring while you're in there.

Do a search on "Jannie411".  She has a great write-up on her procedure and what happens during it.  I had general anesthesia for mine so consequently, I remember nothing.  Always here if you have questions.