New PSVT diagnosis

[Montanan]

Hello!  I'm a 42-year-old male.  I recently completed 24 hours with a Holter monitor after experiencing several weeks of mild, intermittant chest pain, pounding heartbeats, and shortness of breath.  (A stress test was also performed, which was normal.)  My family physician called with the news that the Holter had recorded "several brief episodes" of PSVT.  He said that the condition was "entirely benign," but that I could choose to start taking Toprol if the symptoms were bothersome.  So, here are my questions ... sorry if it's a fairly long list!

1.  Is the Holter recording sufficient diagnosis for PSVT?
2.  The tests were done by my family doctor.  Should I find a cardiologist to look at this?
3.  Should I consider additional testing to rule out the possibility of other conditions, such as ARVD or W-P-W?
4.  Would there be disadvantages to starting on a beta blocker?
5.  Would I need to continue the Toprol indefinitely?  Is this the med to choose?
6.  What about ablation for something like this?  (I live in a rural area ... I assume I'd need to visit a major medical facility for this procedure?)
7.  And finally, is there anything else I should consider (or worry about!)?

Thanks for your assistance ... I've already learned quite a lot reading the forum!

[CCF-M.D.-CRC]

Dear montanan,

1. Is the Holter recording sufficient diagnosis for PSVT?
A: Usually the Holter is a good first step for the diagnosis of paroxysmal supraventricular tachycardia (PSVT) but often an EP test is needed for final diagnosis.

     2. The tests were done by my family doctor. Should I find a cardiologist to look at this?
A: Yes, I would probably make sure that a cardiologist has at least seen the Holter test.


     3. Should I consider additional testing to rule out the possibility of other conditions, such as ARVD or W-P-W?
A: ARVD is not a type of SVT but is instead a VT so it would be less likely. WPW could be a possibility.


     4. Would there be disadvantages to starting on a beta blocker?
A: There are benefits and risks to all medications and this would have to be weighed by you and your doctor.

     5. Would I need to continue the Toprol indefinitely? Is this the med to choose?
A: A bit premature to answer.  It would depend of what type of PSVT you had and what symptoms you were having.

     6. What about ablation for something like this? (I live in a rural area ... I assume I'd need to visit a major medical  facility for this procedure?)
A: Many PSVTs can be cured with ablation and no additional medication is needed.  It is a consideration at some point.
    
     7. And finally, is there anything else I should consider (or worry about!)?
A: Most PSVTs are treatable but I would recommend seeing someone with some special knowledge in this area.

[Deborah]

I was diagnosed with PSVT 1 1/2 years ago.  An ablation was attempted but was too close to the AV node and I would have had to have a pacemaker.  I chose not to at that time, so the physician placed me on Rythmol.  It is wonderful and I have very little problems with my PSVT.  You have to take it 3 times a day, so it gets bothersome, but not as bothersome as a pacemaker and its rare that I have problems with the PSVT.  I also have cardiac microvascular spasms (cardiac Syndrome X), but the cardiologist stated that the PSVT did not cause these spasms to occur.  It is something separate.  I find only basic information on this subject and was wondering if anyone else that has PSVT also has Cardiac Syndrome X?  Please talk to your physician about Rythmol. I was miserable until I received this med.

[Montanan]

Hi, Deborah ...

Thanks for the suggestion about the Rythmol -- I'll mention it when I go in for my next follow-up (in a few days).  It sounds like a fairly "hard-core" medication, though, and I'd hope to avoid something like that if at all possible.

I'm building up a huge list of questions for my doc ... hopefully I won't drive him _too_ crazy! <g>  There's so much research to do when something like this comes into your life -- with our medical system the physicians just don't have unlimited time for you, and you need to do a lot of your own homework.  The internet has been a real help in this regard, but sometimes you still can't find the specific answers you need.  And sometimes the net tells you just a little _too_ much ... it's way too easy to wander around a bunch of medical sites and find a couple of dozen horrible, amazingly-rare syndromes that match your symptoms, and that you just KNOW you've got! (It's sometimes hard enough to keep yourself from freaking out as it is ...)

The best of luck to you --

Mark

[Xtian]

I also Have been diagnosed with "Syndrome x" and have PSVT. This has been going on for 5 yrs and I have not been able to capture my mysterious chest pain spasms on a 30 day monitor (I always get my spasms when I'm not wearing the monitor!). My chest pain is crushing but only lasts for a few seconds and is beneath the sternum. It's very scary and has happened both at rest and with exercise (I run 3miles a day 5x a week), though only occasionally with exercise. Doctors have done all tests including PET scan of heart, Cardiolite stress test, Stress echocardiogram, numerous holters, all negative except for mild mitral regurgitation (1+) and the PSVT diagnoses. I can cope with the PSVT as I often get strange rhythms (doctor suggested Rhythmol since my low dose beta-blocker is not doing much, but I don't like the side effect profile of rhythmol) but the chest pain spasms really freak me out! I am a healthy 34yr old male and have considered an angiogram, but the Dr's don't really want to do it because my chest pain only lasts seconds (not typical of even a cardiac spasm) and has gone on for five years without getting worse.There is no pattern to my spasms. I can get a few one week and then go a month without any pain. I noticed that they seem to happen if I go a long time without eating and also seem to happen early in the morning when I'm driving and had not had enough sleep. I also have a history of panic attacks (sweaty hands, dizzyness, nausea, tachycardia) but often the attacks happen after I get chest pain or out of the blue, and since I also get the pain sometimes while running I can't atttribute it soley to anxiety. Please keep in touch deborah, as it sounds like we have simlar problems. My e-mail is ***@****. Hope you are well.

[Deborah]

Thanks for the comment.  I have been on Norvasc (calcium channel blocker) that really seems to help the microvascular spasms.  My spasms feel like an elephant on my chest instead of a spasm feeling.  The only thing that relieves it is Nitro under my tongue.  I am also on Isosorbide (long acting Nitro) and Atenolol.  All of these combined have made my life almost back to normal.  I can now run up and down stairs (I'm in respiratory therapy)and to codes without losing my breath as much.  Sometimes out of the blue I will have a day in clinic where I'm on the run and have no problems.  Other times it can be a light day, but when I stop and simply walk up a flight of stairs, I'm out of breath.  It's a lot better, but I hate being on all the meds.  My spasms were diagnosed when a heart cath was performed and was seen again when another cardiologist tried to perform an ablation on my PSVT.  Ablation did not take because the site was too close to the AV node and with the spasms, he was afraid he would knock out the AV node.  A friend of mine has panic attacks, but is finding a way to control hers without medication.  She finds that if she does deep breathing exercises in the morning and then again in the afternoon, she almost never has an attack.  Maybe this could help you.  When she feels one coming on, she simply sits back, takes a couple of deep breaths and breathes out slowly.  It helps them to pass fast.  Maybe it could work for you.  Good luck!

[LaurieD]

I have just had a holter monitor on, and it showed 1,127 Narrow Beats within a 24 hour period. My cardio says I am imagining the beats, and that the computer errored. I know I felt them, and I think he's a quack. Does anyone know what "narrow beats" are and why I might be having so many? I also suffer bouts of paroxymal Atrial Fibrillation and PSVT according to a recent holter. Yet my stress test came out fine! Any feedback would be appreciated. My email addy is ***@****

[Deborah]

According to The Merck Manual (excellent medical reference and can be bought in any bookstore) what your cardiologist may call "narrow beats" is: (word for word from Merck Manual) "The term narrow QRS is preferred to supraventricular because these arrythmias may involve ventricular tissue.  One of the most common narrow QRS tachycardias is the reciprocating tachycardia of the WPW syndrome which involves supraventricular structures (atria, atrioventicular node, accessory pathway) and the ventricles.  The 3 forms of regular narrow QRS tachycardia are atrioventricular nodal reentry tachycardia, reciprocating tachycardia associated with accessory pathways, and true atrial tachycardia.  These first 2 forms constitute >90% of all regular narrow QRS tachycardias."  Laurie, hope this information helps.  If you are looking for it in the Merck Manual, it's on pages 1724-1725.

[LaurieD]

Thanks for the info, yes it does help. My problem is also, I have bouts of Atrial Fibrillation and am wondering if these PAC's are anything related to the A-Fib. Some days I get so many, over a thousand. Yet the A-Fib only comes on once in awhile, once every few months, and then usually converts within an hour or two. Stress IS a trigger, but not a cause. They don't know the cause, and it's frustrating. My personal opinion was perhaps these skipped beats are coming on so many because my heart is wanting to go into the A-Fib mode all the time rather than paroxymal. The cardio said these narrow beats were not ventricular in origin, that I didn't have any ventricular activity at all on the holter. He wants to see me for follow up in two weeks. I am currently on tenormin 25 mg tid I wonder if it helps?

[LaurieD]

Hankstar one comment you made concerned me, you said PSVT is USUALLY not life threatening. Can it be? If so, how so? I get like one after another of these beats at times, several a minute. I can't make head or tails of my heart problems I just know I have them, I hate them, they are ruining my life, and my cardio thinks I'm "imagining" them. I have diagnosed MVP (mild they say) diagnosed paroxymal atrial fibrillation (a trip to the er two years ago confirmed I was in the middle of it) and diagnosed via holter psvt. Up until two years ago I suffered palps but nothing out of the ordinary for mvp. Then after the a-fib struck I had more palps, then the last six months or so I've had severe skipped beats. One night I counted sixty while making dinner in about twenty minutes. That's how they go, I can lay in bed and have a bad attack, or be active and have one, doesn't matter what I'm doing. Then intermittently I will get attacks of a-fib also. The only thing common with these arrhythmias is that they are worse around the time of my period, and how I move (bending forward or lifting something) will sometimes kick off an attack. Also empty stomach, going too long without eating will make them worse, as will stress. I can't drink anymore because alcohol brings on the a-fib. I only ever socially drank minimally anyway. But I do smoke two packs a day, menthol which I am sure isn't helping. I am just frustrated and looking for answers.Thanks for your input.

[lexi]

Hi,I enjoy reading everyone's comments, they help me to understand my problem a little better. I had the RF-ablation a year ago and almost immediately following the procedure I started having sinus tach. Dr. believed it was due  to autonomic irritation at the time. Six months and different beta-blockers did not control my bouts with it, and the holter also showed questionable SVT. My EP Dr. said he believed the SVT was ablated successfully, and did not know why I was still having problems. I've since had a tilt-table study done because this is worse when bending or standing too quickly. I'm still on Toprol twice a day, and pre-ablation I was on it once a day. I get many pvc, which are excerbated by fluctuating hormone levels. I am extremely frustrated by all of this and the meds make me very tired, which was the reason I made the decision to have the procedure in the first place. Has anyone else had the ablation with less than favorable results? Thanks for your reply.

[rdb]

I am writing in response to your question asking if anyone has had an unfavorable ablation.  I actually had two.  I have an atrial tachycardia (sometimes calles PAT, PSVT, or IST).  I have been on multiple anitarrythmics with no real relief.  I've had three EP studies all which show this abnormal rhythm, yet the last cardiologist I saw thought it could be stress, as "after two ablations you should be cured" -v ery helpful!!  Actually, the only post-ablation difference I feel is that rather than my heart rate going in the 170's it goes into the 150's.  Still very tired and lightheaded with episodes.  Although I know (thank goodness) this isn't life threatening, it is absolutely driving me crazy and completely interrupting many of my life activities.  Well, enough said.  Just wanted to let you know you weren't alone.  I wish you the best.

[Deborah]

I hate to hear that PSVT is interrupting your daily lives, but I can certainly relate.  I was having very bad episodes with mine and they would hit day or night, rest or activity.  An ablation was attempted, but I would have had to have a pacemaker because it would have knocked out the AV node.  The doctor placed me on Rythmol as a last resort before another ablation attempt and possible pacemaker.  I know, according to drug references and what my doctor told me, that there are some scary side effects.  I have been on them for over a year now and have had zero side effects. Only almost complete control of PSVT.  The PSVT attacks are only about 3 times a month and very mild compared to what they were.  Hope you find something that works for you as this does for me.  My life is great now.

[dodgybeats]

can you tell me the chemical name for Rythmol? Is it disopyramide?  (which is called rythmodan here).  My Dr has prescribed disopyramide for my PVCs but I am a bit scared to take it on account of all the side effects that have been associated with it.

[Deborah]

The chemical name for Rythmol is propafenone hydrochloride.  It is a class IC antiarrhythmic that reduces inward sodium current in Purkinje and myocardial cells.  Drug decreases excitability, condicution veloicty, and automaticity in AV nodal, His-Purkinje, and intraventricular tissue and causes slight but significant prolongation of refractory period in AV nodal tissue.  Like most drugs, the reading of the side effects can scare you, but I have experienced no side effects.  That does not mean that you may not, each person is different.  It is the only drug that has helped and I hope that never stop making it.   Good luck.

[BillyboyAA]

Can someone please help me with a question.  HankStar, you seem pretty knowledgeable about this stuff.  I have recently been fine with PAC's, PVC's, some pauses and stuff like that.  Today I felt a really wierd symptom.  I could feel my pulse as normal, but 1/2 second after each pulse, I felt another pulse in  my stomach for almost a whole minute.  But the pound in my stomach area did not come out in my pulse area.  Very strange.  Could this be A-Fib, PSVT, not sure becuase my rate was only about 100 if that.  Pleas help me..

[BillyboyAA]

Thanx hankstar.  It is just wierd that these were right under my rib cage right under my heart.  It felt like the upper part of my heart was beating and then the bottom part beat 1/2 second after the top.  It was just so coordinated.  I did however feel funny when it happened.  Not sure if it was just anxiety/panic or faintness/lightheadedness.  No chest pain, just the feeling like my heart beat one half at a time.  It's quite embarassing, but this happened one other time about three months ago, but both times were during sex.  It scared me enough to quit and monitor for a minute this time though.  Could this be A-fib.  Possible V-fib since it seemed to come from the bottom of my heart?  I am so scared I am going to keel over and am even more scared to have sex again.  Thanx for helping me again.  My email address is ***@****.  Take care...

[Deborah]

I just received a medical report that was never forwarded to my physician.  The report was never placed in my medical record and I have been being treated for PSVT and cardiac microvascular spasms instead of PAT with microvascular spasms.  What is the difference?  According to the report: "Using atrial axis stimuli, easily inducible narrow complex tachycardia was produced.  There was spontaneous AV block as well as post PBC AV block noted.  The tachycardia was mapped to the para-Hisian area.  Transient AV block occured during each ablation attempt and the procedure was too risky to proceed."  What is PBC?  Is this a typo and should be PVC?  Has anyone heard of PBC?  Thanks for any comments.

[tsco61]

Deborah, I would call the doc and ask if this is a type-o.  I have not heard of that myself.  I could use a little help.  I am a healthy 39 year old male, and had my 1rst SVT attack 3 years ago.  No problems before then.  I have had three attempts at ablation.  They might have ablated a couple of areas but others seem to creep up.   I now have an A-fib and an extra pathway that is too deep in some mysterious scar tissue to burn.  
I am on Rythmol 300 mg 2 times a day.  I have had good luck with the Rythmol.   I experience no side effects.  Well,  maybe feel a little sick at my stomach if I don't eat with it.  
I recently noticed if I do something real stenuous, such as,  digging fence post holes,  I get a slight pain in my chest.  If I rest it goes away.
So I requested a stress test from my cardio.  He didn't think it was necessary because of my risk factors.  The test was with the radioactive stuff and pics.
I am waiting for my doctor to call with the results.  BUT,  what scares me is something the tech said during the test.  About 4 minutes into the test she said my pattern widened and she said it was left bundle branch block.  What is this?  I know it will cause a delay in one ventricle, but is this something new?  or just related to my previous SVT?  I did not feel funny.  maybe slightly dissy,  no pains, and I finished the treadmill.
I am worried about life.  Will these things just keep multiplying?  I am waiting for the doc to call still on picture results.  The tesch said the tread test was inconclusive because heart blockage and LBBB show as a similar problem.
Does anyone know how serious this is?  If it is real serious ,  don't tell me.
Thanks

[Deborah]

Left bundle branch block:  According to the Merck manual, no treatment is indicated.  What degree is the block, first or second?  Third degree is complete blockage. With LBBB, you will sometimes have a prolonged PR interval (this just means that it takes the beat a little longer than usual to go through the AV node).  A good reference is the Merck manual and can be purchased at any book store in the medical reference division.  I am learning all I can about my cardiac microvascular spasms because hardly any of the drs seem to know about it and what causes it.  It has helped me a lot by knowing what I have and that it won't kill me.  I just keep going even when the pain hits.  Hope you find the help you need!