Sinus Tach and Premature Beats

Posted By  CCF CARDIO MD SK on October 20, 1997 at 15:31:00:

In Reply to: Sinus Tach and Premature Beats posted by Jackie on October 18, 1997 at 18:31:24:

: I'm 33 y/o female moderately overweight.  I had an episode of SVT when I was 26 that lasted about 10 hours. Adenosine was given appropriately. It worked for about 3 beats then right back up to 150s - 160s.  Verapamil IV did not work.  I was admitted to the Coronary Care step down unit for observation.  I finally converted on my own.  I was put on oral verapamil, but the side effects outweighed the benefits.  The episodes were infrequent and very short after that.  Maybe every few months for a few seconds. I had a treadmill, echo, and numerous ekgs which were all fine.  Then several months ago I had another extended bout.  Not as fast, about 130s - 140s.  I was put on Toprol XL 50mg.  Dropped my heart rate and BP and made me dizzy.  25mg next with the same results.  I continued taking the Toprol XL 25mg but still had breakthrough tach with dizziness.  Went to another Cardiologist.  Stopped the Toprol cold turkey.  Started me on Dig 0.25 qd.  The next 24 hours were terrible.  I've been on the dig for a month now.  Yesterday, I had premature beats, and some tachycardia with dizziness that started when I went up a flight of stairs.  I became short of breath, this is new.  I vagaled myself down.  I don't like the dig. it upsets my stomach.  I have noticed that when I have these arrhythmias it's righ after I've eaten.  I've had a lot of heartburn with reflux for years.  Any connection, and is the dig necessary.  Should I seek another opinion.  Thanks in advance for your help.

[CCF CARDIO MD SK]

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Dear Jackie,
Supraventricular tachycardia can be from various causes. Hyper-excitable atrium (upper chamber of the heart), accessory pathway, short-circuit in the AV node (AV node reentry) are some of the common causes. The common treatment plans include medications (beta blockers-Toprol, calcium channel blockers - verapamil, digitalis, or other anti-arrhythmic medications) or radiofrequency ablation (RFA). In your situation, it seems that you are having problems with most of the medications. It may be reasonable to have another opinion for possibility of RFA or trial of specific medications. Accurate diagnosis regarding the mechanism of SVT is necessary for efficient management plan. GI reflux or respiratory tract infection can rarely precipitate arrhythmia but usually are not the only explanation for the same. Shortness of breath when associated with SVT needs further attention.
I hope I have answered some of your questions. If you are seeking a second opinion or further evaluation, an appointment with one of our electrophysiology group can be arranged by calling the Cleveland Clinic at  [phone].
Information provided in the Heart Forum is intended for general medical informational purposes only. Actual diagnosis and treatment of any particular medical condition can only be made by your family physician(s).