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Supraventricular Tachycardia with APC's
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Supraventricular Tachycardia with APC's

  I just found out that my Halter Monitor test from last November had reported
  supraventricular tachycardia and APC's. I have had a high heart rate for months
  at around 150-180 beats per minute when standing, or moving around, and 90 beats
  per minute when sitting down. However, each night I wake up with a pounding
  heart beat (150-180), a pain in my top-middle left side which goes through to
  my back, a totally numb left hand, and pain down my left arm. It usually keeps
  me awake for hours.
  My doctor has just given me 10 mg doses of Indural to be taken twice a day. He
  insists this is all caused by stress, but I really don't think there are any
  major stressors in my life at present.
  Please give me your opinion on two things:
  1. Should I be taking this medication without seeing a cardiologist?
  2. Could this be something more serious, and if so, what?
  Please respond ASAP as I can't go too many more nights without sleep!
  thanx, Jennifer
-------------------------------------------------------------------------------------------------------------------------
Dear  Jennifer,
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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