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SVT
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SVT

Hi Doctor,   my mom  is 69 years old. Not overweight.  She had a major argument with my father couple of days ago  and she got extrememely !!!! Worked up. Literarly hysterical. moments later she had a “fluttery” feeling in chest and weakness in legs. Paramedics stated  “SVT” at  220 BMP and gave her 6 mg of adenison intravenously. worked almost instantly pulse down  to 120 .  troponin tests normal and given her metopropol  and told her to follow up with echocardiogram. NO history of heart disease except for occasional hypertension. this never happened to her. Here are my questions.

1. Could  that episode of SVT have actually been a very rapid SINUS  tachycardia?


2. Since the “episode”  came on during an very heavy and extremely stressful argument does it mean that it was just a response to the stress or is it an “electrical malfunction” in her heart?

3. Are Svt’s dangerous?  Can they turn into V-tach or v-fib

4.             If it occurs again can she just perform  vasalva maneuvers like ice water in face  or does she have to IMMEDIATELY call 911

5. Is a cardiology follow up necessary? Or is a regular physician ok  

6. She had a routine echo & stress test in recent past. is a repeat of these test necessary after this particular incident?

7. safe for her to start exercize program?

8. Navanac eye drops for recent cataract surgery. could that be the culprit of the episode? she also takes zyrtec , singulair for temporary asthstma,  norvasc for temporary bouts of hypertension and nexium

9. Is this condition hereditary? Do I or my siblings have to be concerned with this in our future? When asked if there a family history of heart disease what do I answer now?  Yes? Considering she is almost 70 years of age is that still “family history”
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1. Could  that episode of SVT have actually been a very rapid SINUS  tachycardia?

not if it broke with adenosine.


2. Since the “episode”  came on during an very heavy and extremely stressful argument does it mean that it was just a response to the stress or is it an “electrical malfunction” in her heart?

it was probably augmented or help along with adrenaline.


3. Are Svt’s dangerous?  Can they turn into V-tach or v-fib

SVTs are rarely dangerous.  Unless she has underlying heart disease, there is negligible  risk of it causing VT or VF.

4.             If it occurs again can she just perform  vasalva maneuvers like ice water in face  or does she have to IMMEDIATELY call 911

valsalva maneuver would probably work.  the easiest one is lying on her back, lifting her legs and pushing like a bowel movement.

5. Is a cardiology follow up necessary? Or is a regular physician ok  


I would see a cardiologist or an electrophysiologist.  The regular doctor will probably refer her anyway.

6. She had a routine echo & stress test in recent past. is a repeat of these test necessary after this particular incident?


Not if the were done recently and were normal.  Looking at the rhythm strips would be important to determine what this actually was.

7. safe for her to start exercize program?

Probably, but I will leave this to her doctors.

8. Navanac eye drops for recent cataract surgery. could that be the culprit of the episode? she also takes zyrtec , singulair for temporary asthstma,  norvasc for temporary bouts of hypertension and nexium

none of those medications are likely involved.

9. Is this condition hereditary? Do I or my siblings have to be concerned with this in our future? When asked if there a family history of heart disease what do I answer now?  Yes? Considering she is almost 70 years of age is that still “family history”

you can say you have a mom with SVT, but this is not hereditary in general.

I hope this helps.
7 Comments
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213398_tn?1202674074
thank you for your help Doctor. sorry to bother i hope is ok but i have 3 more questions

1. are vasalva manuevers supposed to work instantly or do they take minutes to work? can you try more than 1 manuever during the episode to see which one works?


2. should 911 be called for every episode? should 911 be called immediately?


3. are ablations recommended for paroxismal svt and how effective are they?
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Avatar_m_tn
You sound a lot like me. I have read your posts in the past and like you I have LVH without HCM, but have severe palpitations and anxiety. With this happening to your mother it has brought back fears and are probably once again you are worried about yourself. I know it can be tough for us to admit we need help, but it has to be done.

Like what the good doc has said, unless she has underlying hear disease SVTs are rarely dangerous.
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61536_tn?1340701763
I have SVT.  The maneuvers to break SVT (bearing down, cold water to the face) work immdiately or at least quickly IF they're going to work.  Sometimes it's pesky and one won't do the trick so you have to try another.  If bearing down doesn't halt it, cold water.  You get the idea.

Paroxysmal (brief) SVT is not something people typically call 911 for unless it's the first time they ever had it and don't know what it is.  Sustained SVT needs treatment.  When needed, I think ablations have an amazing success rate - over 97%?
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213398_tn?1202674074
thank you. you answered all of the questions i had. so just to get it straight. she should not call 911 if she experiences it again. unless of  course it doesnt stop with manuevers or last over a half hour or so?  
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61536_tn?1340701763
Only her doctor should determine the best approach to handling the SVT episodes.  If there's anything she's unsure about, she should ask questions.  In my own personal experience, I've never called 911 for this.  I did have someone drive me to the ER once because the SVT kept starting back up.  The right approach for one person could be a dangerous move for another, so as much as I'd like to help I can't say with a clear conscience what might be best for her.  

PS: I've had emotional upsets trigger my SVT too, I think adrenaline and elevated heart rate are catalysts.
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213398_tn?1202674074
thank you again for all your help. i kinda figured that her episode of svt that day was triggered by emotional upset.
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