PSVT?

[skipo1974]

Although my cardiologist cannot say for sure I have SVT I believe that is what it is. I have had echos, sleep apnea test, allergy and asthma test, 24 hour monitors, 30 day monitors, ekg's and most recently blood work, 24 hour monitor and a stress echo. All have showed normal sinus rhythm (athough tachycardia at times) except PAC's and PVC's. Although I was told I had mild Mitral Valve Prolapse in 2002 my most recent stress echo showed none, even though my doc says he hears a "click" or "slight murmur". Whatever this fast heart rate is it wakes me up out of my sleep ( it's always at night). I feel almost like I'm about to have a panic attack (just generally unwell weird feeling) even though my heart is not initially always racing upon waking. I feel nauseaous have to go to the bathroom and then my heart just takes off. Had an episode last night and I actually vomited. The highest mine has ever gotten is 161 but unfortunately it has never been caught. At this point thank God it only happens every couple months and I can get it to stop with vagal maneuvers pretty quickly. I take Atenolol only 12.5 a day because ironically it drops my heart rate in the 50's at rest. Sorry for the long post. I was actually pretty excited because I had attributed it to prilosec because each time I started it I had an episode. I have been taking zantac and I am currently having my monthly (sorry if that's TMI). Just feel so bad because I'm scared to go anywhere now for fear of it happening since I went from having no episodes to getting them now every couple of months. I feel like eventually they will start coming more frequently. My last episode when it was 150 my heart had gotten down to 120 when I was at ER and they said it was normal sinus rhythm. How do I know the difference if its IST, SVT or even something else?

[Chip8]

My AVNRT, indicated by EKG and diagnosed by my EP, only peaked around 144 bpm, at most.  The event, that was recorded on EKG and interpreted by my EP, was only a steady 128 bpm.  It started exactly as Tom described- a sudden increase.  Most of my SVT events ended with the sudden, abrupt decrease back to my normal HR.  However, several times I did see it ramp downwards- in about 20-25 bpm increments.  Perhaps, some other heart condition was happening then.  If so, it hasn't been diagnosed.  Following my failed ablation procedure (SVT couldn't be induced), my EP prescribed Flecainide which increased my PVC and SVT.  I observed text-book examples of SVT while under the influence of Flecainide.  A sudden HR increase to 190-210 bpm, during exercise, and staying in that range until it suddenly fell back to normal levels, in one huge drop, not ramping downwards.  I discontinued Flecanide and the PVC and SVT have not occurred in the month since.  Verapamil was prescribed after the Flecainide...so far, so good.

[tom_h]

The other thing I wanted to mention to you is that typically, each of us has our own SVT "pace".  What I mean by that is all of us have a particular, and repeatable rate at which our SVT happens.  I believe, but am not positive that's due to the particular pathway causing the SVT.  In AVNRT the pathway is very close to and is often part of the AV node.  With AVRT (the kind I had), it's an accessory path located away from the AV node, and often on the left side of the heart (again as mine was).  Also SVT typically has a low end pulse rate.  Your reported 161 is on the very low end of the range.  

Keep in mind one symptom of SVT that is common with everyone who has it: It starts abruptly and ends abruptly.  If it doesn't do that, it's probably not SVT

So between the low rate, and your reported variance of the rate, the gradual slowing of the rate, together with the fact that it has never been documented with an EKG, I'd suspect your self diagnosis of SVT.  I'd look for other possibilities.  Of course, this is just a layman's guess.....

[skipo1974]

Mine is more of a gradual heart decrease than one beat like for instance the other night I checked my pulse it was 154 I bear down and it dropped to 120's then 108 then the 90's.

[tom_h]

The classic symptom of SVT, be it AVNRT or AVRT is its sudden, immediate onset.  There's no ramping of the heart rate.  It can be 72 bpm, and in one beat, be in the low to mid 200's.  Termination of an event is similar, although adrenaline from anxiety may cause the heart to beat more quickly than normal.  Regardless, dropping out of a 240 bpm rate to 130 bpm is an unmistakable feeling.  SVT can also happen during heavy physical exertion like that experienced during sports.  While the difference between pulse rates is somewhat closer, there is still an unmistakable in your chest during SVT.  I had a lifetime of SVT; 6 to 60 before I got it fixed.  Part of it due to the fact that there was literally no cure until the last couple of decades.  The other reason was that I had become accustomed to living with SVT and just dealt with it.

An electrophysiologist may immediately recommend that you get in and have it taken care of, and with good reason.  You're his next paycheck!  The primary "problem" during the electrophysiology procedure is to get your heart to jump into SVT.  This is done by various ways.  They pace the heart electrically, and they inject adrenaline.  Some people like myself jump to SVT merely by touching the heart wall with the catheter.  But there's no guarantee going in that they will be successful in starting an episode, and this is key to finding the source and eliminating it.  Unfortunately, the bill for a failed ablation is nearly the same as a successful one.  With costs approaching $100,000, you want to make sure that they get it the first time.  Either way, the electrophysiologist is making big bucks.  Mine actually had no idea what my hospital (UMAss) charged for the procedure.  He is literally employed by the hospital and receives a weekly paycheck as if he were just a bed pan jockey.

So my advice to you is to make sure your SVT is repeatable.  If it's random, perhaps a couple times a year, you may want to wait a while.  While an SVT event is anxiety provoking, and even frightening, it's not dangerous to a healthy heart.  The thing about SVT is as you get older, it often become more frequent.  I was finally talked into working on mine when it had become 3-5 times per month.  Fortunately, I was always able to convert my episodes. It responded very well to Valsalva.  Yours may not, and this too would weigh large in your decision to try a shot at ablation if you've been running to the ER every time it acts up.  So think hard about it.  It could require a substantial outlay of cash on your part, so you want to make sure that is counts!  Good luck.  Always here.....

[Chip8]

I'm not the one to answer all your questions.  But, I can relate my experience and how my SVT, specifically AVNRT was eventually diagnosed.  My first Cardiologist/EP never diagnosed my SVT, not even while I was in the ER with a 12-lead EKG attached while my elevated heart rate had been occurring for 4 hours.   After that event, I lost confidence in him and referred myself to a new EP, at a different hospital/medical group.  The new EP immediately said that he suspected SVT after I described to him my symptoms and he instructed me to come in immediately, preferably to his office instead of the ER, the next time I was having a prolonged high heart rate.  I did so and luckily it occurred during his normal business hours.  This EKG machine immediately, in about 5 seconds, automatically detected (and printed out abnormal conditions) which my EP interpreted as SVT/AVNRT.  This new EP immediately recommended an ablation procedure.   The EKG machine at the other hospital, in the ER, apparently was a different type which didn't diagnose or evaluate the same way as this most recent one did at my new EP's office.  Also, my prior Echo tests and portable event monitors that I had worn never detected my SVT nor abnormalities, even while I was wearing them and knew that I was having SVT.  

This was my experience with eventual diagnosis and may be unusual.  My own Polar  HR monitor helped me see my prolonged high HR as it was happening (during my exercise-induced SVT) and based on that, I knew that I needed to immediately go to my EP's office for that EKG to capture it on EKG.   Good luck to you.