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AVRNT. 18 year old

Hi all,  I am very stressed to find out that my 18 year old daughter has just been diagnosed with AVRNT. She has been having frequent  attacks, mostly short term, minutes to an hour or so  but two times longer lasting  with a pulse over 200 bpm and needed adenosine injections to rectify.  No lifestyle issues, she is slim, low cholesterol and heart is apparently otherwise OK but I worry that she doesn't eat much and there seems to be a correlation between skipping meals and having attacks, sometimes eating something in fact brings her pulse down straight away.  Has anyone else heard of this?  Cardiologist has said probably no relation. I am confused as to what is causing this. Her normal resting pulse is fine. BP good and up until this diagnosis she was jogging regularly.  Has anyone else been diagnosed at such a young age?  Can it get better with time?  Also does anyone know about a hormonal connection?  I could swear certain times are worse than others.    
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Avatar universal
I would recommend the ablation procedure.  I had it done 6 months ago for AVNRT and was scared to death about getting it done.  However, the actually procedure is relatively easy and painless and the odds of it going 'wrong' are extremely low.  You can read my full report if you look back at my postings.

Best of luck - it seems to be a cure for me after suffering debilitating episodes for 28 years.  Don't go on suffering unnecessarily.
Helpful - 0
Avatar universal
I was just recently diagnosed with AVNRT as well, I am 34 and I swear that I have a hundred triggers: pms time, bending over, standing too quickly, being constipated, being gassy, STRESS AND ANXIETY (esp over palpitations and racing heart) and adrenaline rushes.  I wasdiagnosed with Panic Attacks since I was a teen, but I always knew I was panicing cause my heart didnt beat normally.  I too have used the maneuvers to get out of the attacks, and up until 4 days ago, I had never gone to the hospital.  However, on a recent ECG in the middle of an attack of 195 bpm, my AVNRT also was triggering dangerous V-Tachs, which can lead to fibrilation as well as sudden cardiac arrest.  This is worst case scenario, but very possible, and if I had not caught that on an ECG I would have just accepted the diagnosis of a benign AVNRT problem, but as you find from further research and speaking to an electrophysiologist, VT's can be caused in a serious attack.  I was given the shot to slow down the heart and it didnt work on the first dose because I was absolutelyPanicked!!! I see a cardiologist and electrophysiologist next week...and Ive researched SVT's for years...mine have only gotten worse!! Im petrified of an ablation because of the possibilty of destroying the AV node..more common than people think....what to do??
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Avatar universal
Thank you again, littlegreenman.  Fortunately I live in Australia and we have universal free health care although I have private cover anyway because you get to nominate your hospital. It really bothers me reading some things on here where people need tests or operations but don't have insurance cover. It must be a very tough situation if you can't get what you need.
Anyway i am trying really hard not to be the neurotic mum but I find myself stressing whenever she goes out with her friends although she is being sensible and doesn't drink (it's legal here at 18 and some of her friends do).   I am thinking about the ablation if that's what's recommended.  I don't want her to feel wrapped up in cotton wool all her life. She wants to travel and if she didn't have this hanging over her  I would have to start letting go a bit more.  She's a good kid and while she try to be all grown up I know it bothers her too.
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1398166 tn?1358870523
I look at being 18 (or 40) and having to take drugs... be it Beta Blockers, cocaine, alcohol or heroin as a lifetime chemical dependency problem.

Weigh your options carefully. Note: ablation will max your insurance out of pocket. It's expenseive...but it's safe.
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Avatar universal
Thanks everyone. I am feeling a bit more comfortable and I will definitely try not to stress her out. Littlegreenman, she has had the halter and had  5 short episodes in the 24 hour period but no biggies during that period. Pulse didn't get over 130 while on the monitor. It's been up over 200 a couple of times when I took her to hospital.  she hasn't tried the valsalva technique yet and is not on medication yet but I hope they try these before the ablation.  It sounds less scary.
Helpful - 0
1398166 tn?1358870523
I had the plumber/electrician analogy too.
Plumber LOVE my heart. (electricians love it now too)
The electrician had some work to do.

If it's a garden variety AVNRT, there's a great-great-great shot you'll be offered options for treatment, maintenance or repair.

Yeah, don't stress the girl out. Nobody here's a doctor (me included), so take this in context but: She's not going die on you. Definitly listen above... read about valsalva techniques in the meantime... (I used to "take a knee" and use controlled breathing to stop it). CHILL, and wait to see the Electrician.

Oh, has she had a holter monitor yet??? If not, your fist visit to the electrician might be "a little" waste of time (say if you're waiting weeks for it).  If he doesn't have 24 hrs of tape on it... he'll likely order it before he makes any recommendations. They'll want to see the onset and conclusion. Again, I'm no doc... so I could be wrong... but it's my experience and everybody I've talked to: holter monitor is part of the "chain of events" to the end.
Helpful - 0
1423357 tn?1511085442
As simple as Valsalva is, it's something that should be shown to the patient in person rather than followed off an instruction sheet.  Many people say it's like trying to take a BM when your constipated, but I don't find that at all.  I've always found that a short breath is better than taking a deep one, and I keep my diaphram tense forcing tha air up instead of driving it lower.  I mentioned this in another post:  I imagine that I'm squeezing my lungs and diaphram like a vice against my heart.  Works like a charm.
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Avatar universal
I also started with AVNRT, which is a type of svt, when I was young....12 years old.  My doctor at the time just said there was something wrong with the electrical wiring in my heart, said it was nothing to worry about, and sent me on my way.  And like the others who have posted, I did not grow out of it.  

If anything, the episodes tended to get worse the older I got.  It was especially bad during my pregnancies.  But all of this occurred before I ever received treatment.  While in my 30's I finally saw a cardiologist who put me on a calcium channel blocker called verapamil.  I never had any side effects from that whatsoever. He also taught me the Valsalva maneuver mentioned earlier and it really does work.  I was always able to convert myself, with no episode lasting longer than half an hour (most much shorter)  I would suggest using the maneuver as soon as the episode starts.  It always seemed to me that the longer it went on, the harder it was to break.

Then years later I finally broke down and had an ablation to correct the problem.  I was very scared to have the ablation, but I am so very glad I did.  Not to push an ablation, as she was just diagnosed, but it really does appear to be a relatively easy cure.

But back to your question about not eating possibly bringing it on.  For me, skipping meals was a HUGE trigger.  I always had to make sure I did not get really hungry.  Another thing I had to watch was what I ate.  Obviously avoid alcohol and caffiene, but I also had to moderate sugar and carbohydrates.  Don't get me wrong....I did eat carbs!  But I had to be sure to balance them with protein and other "healthy" food.  If I was hungry and did not have much in me, and then ate a cookie or something....look out!  I was guaranteed to have an episode!  I also sometimes would notice that if I was getting skipped beats, which would lead into an attack of AVNRT, if I ate something healthy it would often make them go away and ward off an episode.

When I was younger, exercise seemed to be a big trigger, and as I got older it seemed to be stress that would bring it on more often.  Maybe both of those are to be expected!

I'm sure you are very worried about your daughter.  It's always worse when it's our kids, isn't it?  (And she is still your kid, even at 18!!)  But hopefully if she tries some of the things mentioned on this forum her episodes won't be so bad.  Stay in touch with your cardiologist, and be open to his/her suggestions of medication and possible ablation.  

Good luck!
Annie
Helpful - 0
187666 tn?1331173345
I've had PSVT all my life and I'm now 58. My rates only got close to 200 (198 to be exact). But I never "grew out of it." I lived with it for years because I thought it was normal. What does a little child know after all? As an adult a doctor happened to catch me during an episode. Told me about valsalva and I used that for years. It wasn't until 2000 that another doctor told me I didn't have to live like this. I ended up having 3 ablations (my heart is a brat with multiple types of arrhythmia). Although I still have some problems they are so much better. When my heart does go tachy, it rarely lasts more than a minute, most often maybe 20 seconds. A huge improvement and I'm considered "healed."  I'm happy with this. It may be something you and your daughter can look into. But the decision is up to the cardiologist.
Helpful - 0
1423357 tn?1511085442
I was also told that I'd probably grow out of it.  You can see where that prediction went.  Your doctor's anaolgy is correct.  There are specialists that deal with the heart's electrical system; electrophysiologists.  They'll evaluate your daughter, and talk about differrent options.  If she's experiencing frequent episodes, her treatment route may be towards an ablation procedure.  Rather than explain it here, I'd recommend that you Google it.  I'm getting it done shortly.  After 54 years, I've had enough.
Helpful - 0
Avatar universal
Thank you so much Tom and Issomething_ wrong. This doesn't sound as bad as I was imagining. Part of the problem getting answers is my daughter will only "allow" me to go with her to the doctors if I don't  speak as she "isn't a kid". Much to my embarrassment she asked me to leave the treatment room at the hospital because apparently I stress her out by looking worried.  She thought she was getting attacks about once a week after the first time in June but the halter monitor apparently showed 5 episodes in the 24 hours. As these didn't seem to last I guess they weren't serious but I'm surprised she didn't seem to feel them. She sometimes looks really pale so I imagine this is part if it. Can it settle down and go away or is it possible to grow out of it?  She still wants to go jogging but I imagine that can't be good either. The cardiologist is sending her to another cardiologist, explaining to her that he is a plumber dealing with pipes and valves which she needs to see an electrician! Thanks again folks. Maggie
Helpful - 0
1423357 tn?1511085442
I was sick at the time with a high fever.  I was only 6, but I remember my entire chest up to my shoulders really aching.  My mother would have never suspected my heart, but after nearly 24 hours in this state, my lips had turned bluish, and that prompted her to call the doctor.  This was when docors made house calls.  One listen to my chest, and off I went to the hospital with my dad driving, and a police car ahead of us running interferrence.  I was converted chemically, but that where I was taught Valsalva.  I still get rates from 225 to 240 if it hits during extremely high respiration rates like I encountered while skating. It's now 12 days until the EP procedure.  
Helpful - 0
1124887 tn?1313754891
Excellent answer :)

312 bpm?! That sounds violent. One question: How did you feel with heart rate this high? Did you faint?

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1423357 tn?1511085442
My first episode was as 6 years of age.  I'm now almost 60.  I was a whisp of a kid as was so up into my 20's.  Mine is not AVNRT but AVRT, but the symptoms are just about the same.  When I was first diagnosed, I was brought to the hospital with a pulse of 312 bpm.  Episodes now average around 200 bpm.  I have about 4 per month.   Let me ask you something:  Has you daughter but instructed on how she can slow them herself?  There's a method called Valsalva that is very effective in converting AVNRT tachycardia.  I've been using it all of these years, and have never had to go to the hospital.  I can usually convert them within seconds of them starting up provided I'm at normal respiration levels.  If my heart rate is high from physical activity, Then it will take longer.  If she is experiencing frequent attacks, this is really somethig she should be instructed on as it's very effective on AVNRT.  It's basically involves taking a short breath and bearing down.  Females on here report a correlation between SVT episodes, and monthly hormonal cycles.  Good luck!
Helpful - 0
1124887 tn?1313754891
Hello.

AVNRT is not a "heart disease", and it has no connection with high cholesterol, blood pressure and other risk factors of coronary artery disease (angina and heart attacks).

A more commonly used term is: Paroxysmal supraventricular tachycardia or PSVT.

To understand AVNRT better: In all hearts, there is a junction between upper chambers (atrias) and lower (main) chambers (ventricles). It's purpose is to delay the impulse so the atrias can pump blood down to the ventricles, which pump the blood out in our body.

In some (most) people, different parts of the pathway leads electricity at different speeds. Which means, they are also able to conduct a new impulse at different times (the electrical system in the heart works almost like domino bricks, which are constantly dropped and raised again). What happens in AVNRT is that a premature impulse (a so-called PAC, which often appears during stress, after coffeine intake, etc) conducts through fibres that are able to conduct, and when it has, it travels backwards through the other fibres that now are able to conduct, over and over again.

Adenosine helps because it knocks out this junction (the AV node) for a couple of seconds, and "resets" the process. There are some other ways to induce a short-term AV block; so-called vagal maneuvers, and swallowing food can actually be one of them. Others are the Valsalva maneuver (blow air towards closed lips), activating the diving reflex (splash ice cold water in the face), carotis stimulation (which should be done after doctor's instructions only due to risk of blood clots in some people) etc.

Many things make us more vulnerable to AVNRT. Everything that causes more PACs (say: 1 out of 100 in some people, 1 out of a million in other people can cause AVNRT) are likely to provoke AVNRT. Stress, caffeine, nicotine, anxiety, hyperventilation and similar things can be a great trigger. In addition, they can make the AV node more vulnerable to start a run of AVNRT.

Remember: AVNRT (as long as the runs aren't sustained for a long time like days) is a fairly benign condition, but it causes great anxiety and is somewhat immobilizing (you don't want it to happen when you're climbing a mountain or swimming). Beta blockers often reduce the PACs and heart irritability and many doctors recommend them. They have some side effects, unfortunately. Ablation ("burning" the problematic pathway) is often done, but there is a slight risk (<1%) of destroying the AV node, requiring a pacemaker afterwards. Today, you can live a completely normal (unaffected) life with a pacemaker that senses the atrial beats, and conducting them to the ventricles.

I would recommend that you stay in touch with the cardiologist and follow his advice. Remember, the condition is not dangerous, but it affects life quality and should be treated if she is very bothered by it.
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