v-tach or afib?

I am 38, healthy, have mild MVP and hx of SVT since childhood.  Take Nadalol 20 mg daily.

In the absence of catching an event on a monitor - which I've not been successful at despite continuous 8 weeks of recording - how do you distinguish afib from v-tach?  How would I subjectively experience the difference between the two, or do they mimic each other?   Is it worth going through invasive testing to determine which is the culprit?  I've been on beta-blockers for over 3 mos and have had no more episodes - is that good enough or is more testing in order?  Both episodes were  only seconds long, but resulted in severe symptoms - immediate near passing out - a feeling of buzzing in my chest -  and I couldn't find a pulse the 1st time, though the 2nd time was in my cardios office and he felt the pulse to be extremely fast and irregular, leading him to believe afib.  Much urination afterwards, along w/ much fatigue.    2 MD friends suggested that it also could be v-tach, which I'm much more concerned about.  If the beta-blocker is keeping the events away, is that enough or should more exploration of the cause be taken?

Also - re: my SVT - why does bending over quickly from the waist bring on brief episodes?  It's a very, very clear correlation for me, and has been happening w/ a bit more frequency (1x/ week) since being on the beta blocker - they only last seconds but shake me up every time!

Thank you, this is a fantastic service.  
To those who pay attention, I'm aware this is a 2nd post in 6 mos and will not post again!

[CCF-M.D.-MJM]

Hi Jennann,

Sorry to hear about your problems.  Let me try to answer your questions.

1.  how do you distinguish afib from v-tach? An irregular heart rate may help, but fast heart rates are difficult to count and may be misleading in the wrong hands--especially if you are almost passing out.  essentially you need to catch it on a monitor to be sure.  although it is pretty rare for a 38 yo healthy person to VT--clearly not impossible-- but a probablistic scale, this is almost certainly SVT.

2. I've been on beta-blockers for over 3 mos and have had no more episodes--

I would continue the beta blocker, but continue looking to capture the arrhythmia for proof.

3. why does bending over quickly from the waist bring on brief episodes?


Do you mean bending over makes  you feel like passing out?  This may be because your blood pressure is a bit lower than it was, it is also possible that the beta blocker is blunting your normal tachycardia response.  when you bend over, you can decrease venous blood return to your heart.  your heart compensates by increase heart rate.  beta blockers decrease that tachy response and may cause dizziness.

If you mean why does bending over break your SVT, bending over and baring down is essentially a valsalva maneuver (increase vagal tone) and can break some SVTs. If bending over (and baring down) breaks your SVT, it is almost certainly SVT and not VT.

I hope this helps.  The most important determinant for a physician here is clinical judgement -- sitting down and talking/examining you.  I am at a disadvantage over the internet.

Good luck.

[tickertock]

sure hope you get a definitive  diagnosis, have you asked about an implanted recorder? Your episodes from what i heard other persons describe sound more a-fib with a very rapid ventricular response, does your ECG rule out WPW or any suspicions of a concealed accessory pathway?

i understand bending can trigger reentrant SVTs, bending tends to trigger mine as well, often with pvcs occuring with the SVT.

what a nasty frightening feeling!!! I know how you feel. after 25 + years and all negative test, i guess i'll just keep on ticking though, like you my episodes are completely controlled with a beta blocker.

[Linda123]

Hi there
Palpitations from the ventricles (in my experience) feel bigger, stronger and lower than palpitations from the atria which feel higher up,lighter and flutteryier(!).  I generally find ventricular palpitations more scarey than atrial palpitations.  I also find my atrial palpitations go faster - and sometimes ventricular palpitations trigger off my atrial palpitations.  Don't try and say all this if you've had a few drinks.......  Perhaps I should try and write a song about it ".. big beats come from the ... ventricles and the little beats come from the ... atrium, now hear the word of the Lord ...., those beats, those beats, those, rotten beats.... etc etc" (sang to the music of 'The Bones' song).
Hope this helps ... (well, you gotta laugh or you'd go mad..)
Best Wishes to you
Linda

[Jeff67]

You are right that some feel scarier than others.  It is also strange how some are felt high, while are felt low.  I have some palps where the ectopic starts well below the rib cage and then ripples upward with the contraction.  Very strange.  I also notice on many of mine that if I monitor my pulse during the ectopic I can feel the ectopic beat ripple through the heart and then after that stops there is a definite pause (feels like 0.5 seconds) before I feel a the beat in my pulse (kind of like the ripple I feel was the ectopic passing through the atria in a strange way and then a pause while it propagates to the ventricles).  Let me ask you a question that I have posted as a general comment before without much response, when you get your PACs, do you often get a compensatory pause? You are not meant to typically due to sinus node reset, but I always seem to get the compensatory pause which makes it tougher to differentiate between PACs and PVCs.

[tickertock]

i know you directed the? to linda , but as you know already , they are PVCs that there no is compensatory pause and PACs that there is a compensatory pause, usually this is not the general rule as you obviously fully have a grasp of. sounds  as though you are wishing and hoping that your problem are PACs conducted aberrantly and not PVCs at all, which might well be the case, some times only EPs studies or a well trained cardiologist or EP can distinguish the difference on a surface ECG.

whether they be pacs or pvcs , the prognosis is basically unchanged once all your other cardiac test are normal. PVCs are the more common of the 2, though they give more rise to a more vigorous cardiac workup. Very frequent PACs tend to be a forerunner of atrial fibrillation or some other type of SVT. Both PVCs and PACs can trigger supraventricular tachycardias.

PVCs or NSVT very rarely trigger dangerous arrhythmias in an otherwise normal heart even when the PVCs are very frequent.

It is much more common for frequent PACs to be a forerunner of atrial fibrillation, a more serious arrhythmia, but very common arrhythmia, stroke same to be highest risk and a rapid ventricular response when not control can lead to heart failure.

Even though PVCs tend to more symptomatic for the majority of people,Frequent PACs can actually sometimes be a greater potential for the development of a more serious rhythm problem like afib. This is only my interpretation of these 2 bothersome ectopics as I understand, rely only on the advice , diagnosis, and prognosis from your doctor.

[jennann]

Thanks for all the comments.  I do not have WPW - though my brother does!  My sister, brother and I all get lots of ectopics, but I'm the only one w/ the SVT as well.  Tickertock, what are your "events" that have been controlled w/ beta blockers?  Do you have afib or NSVT?  Also - anyone else ever get a strong pinching feeling in the heart?  No pain anywhere else - but the pinching has been there for the past 2 days, on and off.  Cardio has not returned my call yet!  One more....anyone else get horrific nightmares from the beta-blockers?
I see an EP for the 1st time next week for a 2nd opinion.  Hopefully I'll get more answers there - it's all so confusing and frightening.
Jennifer

[tickertock]

My events are PVCs, PACs, sinus tachycardia, and some docs called PAT, others just sinus tach with PVCs, all have been documented on ECG, one short run of NSVT caught on holter nearly 20 years ago. I was never aware of it even though i awake at the time. I still get the odd PVC, but no tachycardia at all and yes the only side effect I suffer from beta blockers are nightmares, but i prefer the nightmares anytime. Hope you find out whats wrong, very interesting, I think you said your brother has WPW, you might have concealed WPW, only diagnosed by having an Ep study.

[Jeff67]

Thanks.  Whether they are PACs or PVCs in themselves is not really the issue.  For me, often when I get a burst of something it is at a time when immediately before or after the burst I am getting ectopics with compensatory pauses.  These are more likely to be PVCs based upon the fact that I have the pauses, so I am thus assuming the burst is likely VT.  I have been trying to understand whether the "typically PACs do not have full compensatory pauses" applies to the general population or each individual.  In other words, do most people have no compensatory pauses with their PACs while a minority have compensatory pauses with every PAC, or does each individual have the majority without full compensatory pauses but some with pauses.  Do you have any idea about the mechanism that leads a PVC to precipitate an SVT?

[tickertock]

My comment in the above post saying that you might have the concealed form of WPW was only my opinion and in no way intended to diagnose your problem as noted I said it could only be diagnosed with an Ep study. In some literature there appears to be a genetic link with WPW. I am not a MD.

[Linda123]

Hi Jeff
Yes I do feel pauses, along with all the bips and bumps.
Best Wishes

[tickertock]

As I understand PVCs are triggers for about 30% of all SVTs, timing is everthing, the PVC has to occur in a specific cardiac cycle. As I understand this usually involves some types OF AVNRT, but tend to occur more frequently in concealed accessory bypass tracts, also referred as to concealed WPW.

As a rule concealed accessory pathways usually conduct in a retrograde manner from ventricle to atria and rarely causes wide complex tachycardias.

[jennann]

Jeff - what does your "burst" that you think is NSVT feel like?  Wondering if that's what I have...
Tickertock - interesting about concealed WPW - never heard about that, not that I would have!  I'll certainly ask the EP next week.  And of course I understand that you're not an MD - but thanks anyway for the disclaimer!  Have you noticed whether anything helps or worsens the nightmares?  I was far worse on Toprol than Nadolol - but still are there.  I agree that it's better than feeling all the ectopics...but my cardio actually wants to pull me off if nightmares continue??????  Not sure why, and not sure I'll agree.
Jeff (again...)  when I was event monitored for so long, I mainly had PVC's w/ some PAC's.  I can't tell them apart, but know for sure that I could feel the beat...beat...beat...pause...THUMP.beat...beat...etc. I know that many of those were indeed the PVC's, but as I said, I don't even know if I experience pacs the same way.  I know I do feel them, though.  
Anyone re: the pinching?  
Thanks again,
Jennifer

[Jeff67]

With the burst I first feel a strange ectopic (forceful and the contraction itself takes quite a while), then immediately after that ectopic I get a few quick forceful beats, then a pause and back to normal sinus rythm.

Pinching ... do you mean with each ectopic or just continually? I definetly get pinching/pain with many ectopics.

[jobob52 ford]

Hi, I had quite a history with both VT and A fib. Almost 30 yr. For me when in VT it was like a switch flipped and pulse was at 250 and steady until it was over(sometimes for hours) and it stopped the same way. I felt kind of a whosh when pulse went from 250 to 80. just like that, it was over!
With A fib it was as though there was a dimmer switch, can go up, down, down up fast, up down slow. Pulse would rarly go higher than 180 and lower than 40. It would just be all over the place and it was at those times I'd feel not as much dizzy but more like whoozy. This also could last for hours.
In my opinion, if you have found medication that keeps these symptoms at bay, take the meds and forget about it. Don't give it another worry, see your cardio once a year and be thankful.
Hope this helps. Good luck, Bob

[VikingColumbus]

Greetings Everybody,

    May I jump in with a question, given this thread
speaks to vtach and or svt episodes?

    I experience either nsvt or svt. Most likely svt
because I've been thrice given meds in ER to 'break'
a resistant episode. I get 'bursts' of svt/nsvt now
and then.

    I essentially have the slow-mo type(s). But, funny
thing, I will have an svt/nsvt episode begin and then
stop for a few beats of normalcy and then begin again
and then shortly stop/resolve back to normal rhythm.

    This back-to-back phenomenon is a relatively new
twist for me. Anyone else experience this type of cardiac
behavior?

VC

[jkf]

Hi.  I was diagnosed with PAT many years ago.  Do you notice that right before it happens you get a very long pause then the PAT starts up?  This only happens to me about 2 times a year so I am sure the circumstances have to be just right (the timing of the pvc).  However, that pause is much longer that the normal one between pvc's.  This pause last at least a couple of seconds then boom the PAT starts up.  And, the PAT for me is a fast heart beat of about 220 and irregular because the pvc's are acting up at the same time.  I hate it and am grateful that it only acts up a couple time a year.  Do those extra pathways ever just go away or is that what ablation is for?  Jodie

[tickertock]

Hi,

Jodie when I used to get the attacks thats how they would they would start a long pause, then boom , the PAT , with PVCs(definitely) PVCs occuring with the PAT, caught on a ECG with a rate of around 200 bpm. At that rate with frequent PVCs occuring at the same time it is hard to tell the difference feeling your pulse from afib, though afib is much more irregular.

With these concealed bypass tracts ablation is the choice of therapy for a complete cure, at 2 to 4 time a year, you have to ask is is work the relatively small risk with an invasive procedure when the risk of a malignant arrhythmia occuring is practically zero or so I have been told by every doc I ever seen, including a EP.For me these episodes usually happen the same as you 2-4 times per year lasting maximum 10-15 minutes , juts barely long enough to be caught, no medication(intravenously that is) to halt them whatsoever , just a a beta blocker orally to slow the rate.

Hope this has been of some help.

[kuc]

Jennann,

I have had svt for 20 years, and I can relate to you saying that bending over sometimes causes you to go into "SVT."  Not only bending over, but doing other things such as jumping up and down or just sudden movements causes my heart to freak out.  Doctors never could explain to me why that happens.  I had a ep study and ablation in January and have felt great ever since, so hopefully my problem is fixed.  Good luck to you!

[tickertock]

Hello

Just curious was your SVT, AVNRT or AVRT? great to hear the ablation was an apparent success.
THanx.

[jennann]

YES!!!!!!!!!!  That describes me too...I remember it being set off as a kid from dancing, and now at times from such things as sneezing, jumping, and the bending over I mentioned.  Even "violent" hiccuping can do it.  Hopefully the EP I see next week will shed some light on why.  Did you have the ablation just for the SVT or other things as well?  How bad was your SVT?  Mine's not too bad - much worse as a kid b/c I didn't know it was abnormal and kept doing what I was doing...dancing, hiking, roller skating - leading the SVT to continue for long periods.  Now it's just seconds, and not often.  It's crazy...the MVT, SVT, pacs and pvcs, and now maybe afib or vtach.  What's going on?  And many MD's would say none of it is connected to the other...hmmm...

[kuc]

My svt was diagnosed as AVNRT.  I had my first episode at 14, and I'm 33 now.  I was playing basketball when I had my first episode. Even though I knew my heart was beating out of control, at that age you don't really give it a second thought, and it would always go back to normal by itself.  I told many doctors about it, but of course they could find nothing wrong, so it was not diagnosed until I was 26.  My rate was around 220-240.  SVT is the only rhythm problem I have, but of course I do get the pac's and pvc's.  I hate those things!

[tickertock]

Thanks for the response, wishing you continued success with the ablation.Good for you.

Regards.