Could palpitations be slow SVT?

[jtznh]

Hi, I have a question about palpitations. I have been diagnosed with PVCs and PSVT which I can usually correct by bending over. The palpitations have all been checked out as benign. I've had ultrasound done and the PVCs and PSVT have been caught on the EKGs, and I'm told there isn't any structural problem. I'm 31, non-smoker, in great shape and get a lot of exercise.

Sometimes though, I get different palpitations that give me the same weird feeling in my chest I get with the SVT, except with a very slow pulse (40-80 I think). This only happens if I'm at rest. This is hard to describe, but maybe it feels like a frog deep in my throat, and my pulse sort of pounds, and I know it isn't a normal heart beat. It almost feels like I'm in shock and I'm not getting enough blood. When this happens I get pale, dizzy and unsteady, and pretty scared, even though I'm used to the usual SVTs and they don't scare me anymore.

The slow palpitations will then speed up to be SVT, hang around for a while, and eventually my heart will reset itself (usually with a trick like bending over or the valsalva maneuver).  Since this is rare, it's never been caught on a monitor (unlike my PVCs and SVT which have).

So my question is, does this sound like part and parcel with the other benign arrhythmia? Can SVT be slow, does that make any sense? Or does this sound like something different I should worry about? Thanks!

-Josh

[CCF-M.D.-MJM]

Hi Josh,

It is very difficult to tell without catching it on a monitor.    Most PSVT or VTs warm--that is start slower and accelerate.  SVTs like the one you describe, that break with vagal maneuvers like valsalva and bending over, usually start at one rate and stay at that rate until it breaks.

One possibility is your heart is beating fast enough that you can't feel every heart beat.  If the beating is irregularly, irregular, it may be atrial fibrillation, but again, you need to record it on event monitor.

Although it can happen, it is unusual for someone to have two different arrhythmia's through a different mechanism.....in otherwords, SVT and VT don't usually occur in the same patient, especially a young person.

Less likely but always in the differential, anxiety attacks cause accelerating sinus tachycardias.

It always boils down to catching the rhythm on monitor though.....

Hope this helps.

[hankstar]

Sounds like the feeling I have when I had bigeminal PVCs, a PVC every other beat. Another cause could be AIVR(accelerated idioventricular rhythm) just a thought. Good if it could be caught on a holter to identify the rhythm.

  Best wishes.

[jtznh]

Thanks for the comment. Sometimes I do get PVCs twree, four times in a row. Strangely, foods with raw garlic seem to trigger this. But this never makes me pale or unsteady and it doesn't bother me anymore, I'm very used to that feeling. The "slow SVT" feeling is very different, not like "skipped beats" but like a totally different rhythm. My hope is that whatever busted pathway causes the SVT can also cause this strange, slow rhythm, that it's the same, just at differen speeds. I've never heard of AIVR before though.. This will be hard to catch on a holter .. it only happens maybe once a year at most!  Thanks, -Josh

[WPWGuy]

I wonder if you could figure out what triggers it?

It took a while (15 years maybe) for me to catch mine. It changed over that time, becoming more lengthy and predictable. I found mine to be correlated with strenuous exercise after laying off for a while. Symptoms similar with yours.  Pulse rate much higher, however.

[Cashiers]

I'm coming out of this type as I write, the dazed and confused feeling is real alright.  It is weird, I am going to Duke on the 13 th for second ablation.  Have had all monitors and boy this one would have been a good recording.  I have tack standing and doing anything strenuous or just sitting, they ablated PSVT a re-entry loop.  really helped, but the PVCs really became obvious since then, then had another big event end of Sept, since then have this problem of being able to to do anything.  Like I blow a gasket or something.  Still right now am really cranking sitting.  I sure hope they can ablate this.

[WPWGuy]

Sorry to hear of your troubles.  Please let us know about your experiences with the doctors at Duke. Good luck and god bless...

[mmfd]

I think it does sound like accelerated idioventricular rhythm.  It feels totally differently than a *regular* rhythm, although it is a regular rhythm, (if that makes any sense).  My normal heart rate is around 54-56 bpm.  When I have the AIVR the rate goes up to about 80-90 which is not fast but defintely faster than my normal.  It does feel like it's coming from an entirely different place in the heart.  I never have had any symptoms with it like lightheadedness or anything, but it sure does feel strange! I can tell you that I used to get it a lot and it was captured on a Holter.  The cardiologist was totally unconcerned.  My PCP was a little wary, but got over it.  I seldom get it now, but I am on Amiodarone for other non-related cardiac problems :-) Since you only get it about once a year, I would just forget about it, and try to relax!