NSVT questions

[brian72]

Thanks in advance for answering our questions. Posted a while back, so this is my 2nd question for the 6 months. I've had all the tests and they were all negative, holter, nuclear stress test and echo. Holter showed 6 SVT episodes and a handful of PVC's/PAC's.
1. You mentioned NSVT feels exactly the same as SVT in most people, I've heard SVT described as just fast but regular, can it feel irregular, like a rhythm thats "stuck"?
2. The NSVT episodes I feel I had were within a month or so and haven't occured since in about 7 months.  Could they have been triggered by outside factors at the time of the occurences such as too much caffeine, smoking, being overweight and eating poorly? Or do those factors simply aggravate an underlying condition?
3. If they were caused by any of those factors alone, if I were to change those habits, is it likely they may never happen again or if a person experiences NSVT are they more likely prone to more occurences over their lifetime?
4. Being that they were isolated to that time frame, does that point to outside factors as the possible cause?
5. Whats to keep NSVT from continuing into VT in a healthy, normal heart?  
6. What regulates a rhythm like bigeminy or trigeminy as opposed to just having random frequent PVC's?

I can handle the isolated PVC's/PAC's, its the runs that I feel I had last year that have me concerned. I thought nothing of them at the time but since I've had an increase and change in PVC's/PAC's, it feels like its just a matter of time before those runs return. Any reassurance would be appreciated. Thanks Doctor.

[CCF-M.D.-MJM]

Hi Brian,

1. You mentioned NSVT feels exactly the same as SVT in most people, I've heard SVT described as just fast but regular, can it feel irregular, like a rhythm thats "stuck"?

I should clarify that statement, it is a bit confusing.  NSVT by definition is nonsustained, by definition less than 30 seconds.  It is important to say that 99% of the people we see with NSVT have only 3-8 beats of VT lasting less than 2-3 seconds.  Most SVTs are also short runs of 3-10 beats, but a sustained SVT is much more common.  If your symptoms are fleeting lasting only seconds, I doubt you could tell the difference between the two.  If it is sustained, they would also feel similar but very different from nonsustained.

SVT is usually very steady and regular, that is unless it is atrial fibrillation.



2. The NSVT episodes I feel I had were within a month or so and haven't occurred since in about 7 months. Could they have been triggered by outside factors at the time of the occurrences such as too much caffeine, smoking, being overweight and eating poorly? Or do those factors simply aggravate an underlying condition?

If it was a reentrant rhythm like most SVTs, the underlying substrate has to exist before you can have it, although stress and caffeine certainly can help that along.  SVTs and panic attacks are very similar and can occur like this as well.

3. If they were caused by any of those factors alone, if I were to change those habits, is it likely they may never happen again or if a person experiences NSVT are they more likely prone to more occurrences over their lifetime?

If you experienced it once (SVT or panic attack), it is possible for this to happen again. The key is to find the underlying trigger if one exists (sleep deprivation, stress). There is no way to know for sure.

4. Being that they were isolated to that time frame, does that point to outside factors as the possible cause?

It may, but it is difficult to prove unless the same set of aggravating circumstances happened again.

5. Whats to keep NSVT from continuing into VT in a healthy, normal heart?

I have never seen or heard of that happening with a normal heart.

6. What regulates a rhythm like bigeminy or trigeminy as opposed to just having random frequent PVC's?

There is no way to know for sure.  It could be reentrant, increased excitability of the heart cells, something called triggered activity.  We don’t know the answer to this question yet.

I hope this helps.  Thanks for posting.

[madgrad92]

Hi, Brian72,

I have actually caught on a monitor a 13-beat run of what the docs originally thought was a NSVT but now are almost 100% sure (because of P-wave retrograde - which I don't understand the meaning of at all - if someone out there knows, I'd love an explanation) was actually SVT with aberrancy. According to my 2 cardios that I've seen, NSVT and SVT feel the same - no way to tell one from the other just by sensation. Once, when I felt an "irregular" tachycardia(the beats seemed to have irregular spacing between them), the doctor surmised that it probably was a short bout of bigeminy w/ my PVCs (on "bad" days, I get about 200 PVCs - very rare bigeminy).

I have heard that you can usually stop or slow an SVT with the valsalva maneuver (bearing down like you're having a bowel movement), but that an NSVT will not slow or stop from that. My cardio has assured me that an NSVT in a structurally normal heart will VERY rarely become sustained, and will almost NEVER become V-fib. I can sense your anxiety, and that's the hardest part for me. On anxious days, I am so hyper-aware of my heart, I can convince myself that the next irregular beat is going to be a death sentence. On days when I'm feeling good and feel that I can power through these, the blips hardly affect me. Like many, many, many doctors and people on this forum have assured us, in a structurally normal heart, these things (yes, including NSVT) are a mere nuisance. Easier said than done, I know (trust me, I know - I'm still in therapy), but you will live a long time, even with an occasional VT thrown into your days! I think the hardest part is getting over the anticipation of "what's next?"

In addition, my doctor told me that NSVT CAN be caused by anxiety. AND, he explained that there are LOTS of people in the world who have NSVT but don't even feel it (as there are people with PVCs. It's only sinister (according to my docs) in someone who is post-heart attack.

Looking forward to the doc's response. Feel free to email me at ***@**** if you have any other questions.

Dyan

[Fran71]

When you say NSVT feels just like SVT, by SVT do you also mean sinus tachycardia? I know that sinus tachy is a type of SVT, but usually by SVT we mean the tachycardias arising in the atria. If they all feel the same, I guess the only difference between sinus tachy and the other types is that the former can last for hours, whereas the latter should only last a few seconds, or they would become sustained. Is that correct?
Thanks!

Fran

[dmbe70]

I thought SVT meant Supra Ventricular Tachychardia???

[madgrad92]

My understanding is that sinus tach means that the heart is in a normal sinus rhythm - atrium then ventricle, and so on. SVT means that a preexcitation beat in the atrium suddenly creates a very fast rhythm in which the heart isn't "resetting" to its normal rhythm - the AV node isn't regulating the beat - some other errant pathway is. Sinus tach is what we're in when we're exercising, but SVT is an irregular rhythm where it's almost like the ventricles are trying to "keep up" with the atrium. Again, that's just my understanding. Not sure if that helps.

[wmac]

When I have had SVT and NSVT they feel totally different. Svt feels like very fast sometimes even faint not really strong. But the NSVT when I have had it feels like a pvc but with many in a row it doesnt feel like its going fast when it actually is. THUD....THUD....THUD....THUD.... AND SO ON. I also feel the pause. Its a very terrible feeling. They feel strong and slow. The 26beat run I had (was recorded) felt like THUD WITH A VERY LONG PAUSE AND THUD AGAIN. Hope that helps.
Hope you all have a good heart day.
wmac

[PikaPika88]

When I've my regular fast beat, they said is SVT (PAT).  Last year I told my cardio I've irregular beats and vibration in my chest.  He said my heart muscle is getting old.  The upper chamber of the heart is not working properly.  He said is A-Fib to my GP.  Now he said is anxiety to me.  He told me I didn't have any PAC or PVC.  Now I wish to know what I have?  Can anyone have a guess for me please?  

Pika

[brian72]

Thanks for the input everyone.  What I felt were strange beats, each one was different with no pause in between though.  And it was for about 10 seconds I'd say. Anyone feel anything similar?  Interesting the Doctor said 99% only last 3-4 seconds.  I suppose we can take solace in the fact that he said he's never seen NSVT continue on into VT in a normal heart.  Normal is defined by all the testing I gather... stress tests, echo's and holter right?

[gismatrix]

Hopefully someone can help me, since I can't seem to win the question lottery.  I had an ablation for AVNRT on May 19th at UPMC (pittsburgh) and they told me it was successful.  Since that time I have had a few PVCs and my heart rate fluctuates a little more than usual (they took me off of the metoprolol I was on) and is mush higher (sinus tach some of the time 110-120).  All of that was expected.  However, last night I felt about a six second run of my SVT...it immediately stopped on its own.  Is this normal?  Does this mean that my SVT is returning?  Has anyone else had a successful ablation that experienced these little episodes while healing?

Thanks for all your input and God bless.

[madgrad92]

Brian, I think you got an EXCELLENT response from the doctor - I think he reassured a LOT of us (thanks, doc!). I truly believe you're feeling either bigeminy or trigeminy PVCs - a diddlediddle THUMP....ba-boom, ba-boom, diddlediddle...THUMP (sorry for the sound effects - not sure how to better describe it!) I am pretty certain I have SVT and not NSVT, since it feels very regular but just very fast (and a little "far away" like wmac explained - kind of faint). I think you're having the same. GREAT REASSURING answer by the doc. Never seen a healthy heart go into VT or V-fib. WOO HOOOO!!

wmac, how have you been? We haven't talked via email for a while - hope you're feeling good lately.

Dyan

[Fran71]

As I understand it,  sinus tachycardia is a type of superventricular tachycardia. By SVT though we usually mean those originating from the atria. However I clarified that in my question so not to be misleading.

Great response by the doctor! Thanks.

I was wondering if all of you people with PVCs have been prescribed a stress test? I never took one, and my cardio never suggested I do.

Thank you
Fran

[ericaa]

I had a 7 beat run of VT captured on an event monitor when I was 7 monthes pregnant. I had an echo which was normal but my cardiologist still wants me to get a cardiac mri after I have the baby and an EP study. Just curious as to what tests everyone else had as a result of the NSVT....

I am taking atenonol which helps but I still get runs of PVCs as well as frequent isolated PVCs so I can't help but be a little worried, especially since I still need more testing. I am also worried that I am still getting runs of NSVT but just can't feel it now because of the beta blocker.

These heart things suck! It's so hard to just believe that it's ok...

[madgrad92]

I know exactly what you're saying, Erica. Let me reiterate for you what a GREAT cardiologist (compassionate, warm, understanding) said to me: "Dyan, regardless of whether this is one PVC a minute, 20 PVCs minute, SVT or NSVT, it makes NO DIFFERENCE in a healthy heart. NONE." I asked him, "But what if it gets worse?" He said, "So what? Your heart is HEALTHY." I, too, get really, really worried over this stuff, but I will tell you, the anxiety makes it 20 times worse.

You should expect for him to do a stress echo (as well as the MRI that he already said he'd do) and most likely put you on a 24-hour holter or an event monitor that you wear for a month or so. You are going to be totally fine - lots of these symptoms come with pregnancy (strangely enough, however, mine went away during both of my pregnancies. Go figure.).

Story my cardiologist told me: An 86-year-old man walked into his office (after having made an appointment to do so) and said, "My heart's been doing 'that thing' again." This man had suffered PVCs/PACs/SVT/NSVT/AVNRT/you name it. Apparently, his heart was, at the moment, in an SVT. The doctor said "How long has it been doing this?" The man answered, "About 3 days straight." The doctor said, "non-stop?" Non-stop, was the man's reply. Anyway, they brought the heart rate down. The man is now 94 and totally healthy. I would be in the ER if my heart were like that for 5 minutes, let alone 3 DAYS!!! Just goes to show how strong our hearts actually are. You're going to live a LONG life.

[Fran71]

Great post, madgrad! I envy the attitude of that man....

[woodruff]

"I was wondering if all of you people with PVCs have been prescribed a stress test? I never took one, and my cardio never suggested I do."

I have had pvcs off and on for years, Fran, but my EKGs were normal, and no doc ever suggested a stress test until recently, when, for some reason, I ran very high BPs for a month or so.  THEN, my doc ordered a stress test.  Not for the pvcs, but for the high BP/pvc combo.

The test was a piece of cake, kind of fun actually, though there were a LOT of technicians in the little room for the echo/treadmill test.  My pvcs virtually disappeared with exercise, and the echo revealed a bit of valve leakiness, especially the aortic valve, which no one expected.  As a result, I am now to take antibiotics beore tooth cleaning, but that's about it.  The pvcs continue to come and go, and my BPs have mysteriously dropped back to low normal without treatment.

[Fran71]

Thank you! That is reassuring.

[carothers]

A related discussion, nsvt, max hr and exercise was started.

[carothers]

A related discussion, nsvt, max hr and exercise was started.