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Is this SVT?
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Is this SVT?


  On Feb.10, 1999 I was washing a window when I felt like I could'nt breathe which made me cough. Then I realized my heart was pounding extremely fast. I don't know how fast it was at this time but it lasted for a minute or so. Then I became very nauseated and shaky. This lasted for about 3 hours. After this time a nurse instructed me on taking my pulse which was 144. I went to the E.R. where an EKG and blood tests were normal. Weeks prior to this incident I went to the doctor for sharp pains running through my heart which came on and off for 4 days and lasted a few seconds. I was also experiencing loss of sensation in my pinkie periodiacally and the same feeling on one side of my upper lip for weeks prior to the tachyardia. Feb. 11th my doctor put me on Toprol 50mg. I also had a electrocardiogram that showed mild MVP. For weeks after this incident I was extremely thirsty, drinking only water.I was also fatigued staying in bed for 2.5 weeks and I had no appetite. I lost 10 pounds in a week. On Feb. 20th I wore a heart monitor which showed ST segment depression and periods of tachycardia up to 143. Later echocardiograms showed no MVP. From Feb. 25 for a week I got a burning sensation through my chest that felt as if someone were shocking me with electricity. I get shrarp pains in my left arm that last for days, go away, and then come back for days at a time. I am 28 and thin and prior to this have enjoyed good health except for a benign tumor I had removed from my left arm. I also have had2 small swellings in the top of the back of my neck for 8 months that doctors have said are swollen lymph nodes and nothing to worry about. My stress test was O.K. Is this SVT? My doctors think so.
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Dear Michelle,
Thank you for your question. There are many causes of tachycardia  (fast heart beat) and they can be divided roughly into sinus (originating from the sinus node or heart's natural pacemaker) and non-sinus tachycardias.  
Nonsinus tachycardias are either  supraventricular (coming from the upper chambers of the heart) or ventricular (coming from the lower chambers of the heart).  Supraventricular tachycardias are also know as SVT's (supraventricular tachycardia) and include:  paroxysmal supraventricular tachycardia (PSVT), atrial flutter, atrial fibrillation and AV nodal tachycardia.

The treatment of SVT depends on what type of SVT it is.  PSVT is often treated with a catheter ablation but may be treated medically as well.  Atrial flutter is almost always treated with ablation now days.  Atrial fibrillation is usually treated with medications but may sometimes be treated with certain surgical and interventional methods.  AV nodal tachycardia can also be treated with ablation.  It may not be possible to tell which type of SVT on has from surface ECG recordings and if that is the case a special type of study called an electrophysiology study is performed.
Sinus tachycardia is defined as a heart rate of greater than 100 beats per minute originating from the sinus node.  Sinus tachycardia is classified as either appropriate or inappropriate.  There are many causes of appropriate sinus tachycardia such as exercise, anxiety, panic attacks, dehydration, deconditioning, volume loss due to bleeding or other loss of body fluids, hyperthyroidism, electrolyte abnormalities and many other conditions.
Inappropriate sinus tachycardia can only be diagnosed when all causes of appropriate sinus tachycardia have been ruled out.  It is not clear what causes inappropriate sinus tachycardia but possible etiologies are an increase in the rate at which the sinus node depolarizes and an increased sensitivity to adrenaline.  Once the diagnosis has been made by ruling out all of the potential causes of appropriate sinus tachycardia  there are several treatment options.  If the symptoms are not overly concerning no treatment needs to be done.  There is no increase in morbidity or mortality in persons with this condition and they can expect to have a normal life-span.  For persons in whom the symptoms are unbearable medications such as beta blockers or calcium channel blockers can be used, usually with good results.  In the rare person unable to tolerate medical treatment catheter ablation (burning) of the sinus node with insertion of a pacemaker or surgical removal of the sinus node have been used in the past.  Newer techniques are being developed using catheter ablation to modify and not destroy the sinus node thus avoiding the need for a pacemaker.
As you can see the diagnosis and treatment of tachycardia is not straight forward and oftentimes a specialist is needed.  The type of cardiologist who treats these type of problems is called an electrophysiologist.  Your doctor can refer you to one if needed or you can probably find one at the nearest major medical center.
Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.




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