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Supraventricular ectopy
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Supraventricular ectopy

I am 57 years old and a long time runner an cyclist with over 30 years of aerobic activity.  On a regular basis I have done workouts with my average heart rate will be between 155 and 160 for 20 to 40 minutes.  My resting heart rate is around 42 to 45 and a max around 180.

Last October I noticed my heart skipping beats and pounding .  I have a sport heart monitor and noticed my heart rate jumping from around 140 to 188 or higher for brief periods. I visited my family physician where these problems were confirmed with an EKG.  Since that time I have been through several tests including an Echocardiogram, a 24 hour Holter Monitor, Blood tests, and a Nuclear Stress Test.  

The interrpretation is;  

- underlying sinus rhythm with period of sinus bradycardia, sinus tachycardia and intermittent atrial flutter with varying degrees of conduction

-Occasional premature ventricular complexes occurred, including rare couplets , triplets and trigeminy.  
Two ventriular runs occurred the logest run was 9 beats of ventricular tachycardia during exercise.

-Frequent premature supraventricular complexes occurred, including frequent pairs, occasional bigeminy and trigeminy and occassional runs of SVT.

All of this confirmed there was no underlying problem with my heart that was causing these problems and I am now being referred to an Electro-physiologist .    

I would like to return to  regular exercise since it is so much part of my life style but have backed off until I can get some understanding of what this means.

1.  Am I at risk if I return to heavy exercise?

2.  Is there any cure for this?

3.  What brought this on so suddenly after all these years.




This discussion is related to what is supraventricular ectopy?.
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251395_tn?1395961265
Hello...

It is hard to say what brought this on so suddenly. There are many triggers that could activate SVT. In my case, it was sonething that I was born with. It remained dormant, minus minor palpitations, until I was 28.

You mentioned that you had an echo, stress test and blood work. What were the results of these? For some people any type of exercise seems to trigger occurence of their arrhythmia. My comment on whether or not you are at risk during heavy exercise...this would be a question that should be addressed by your Dr. I really can't say that there would be no risk. If your previous testing yielded no findings of heart disease I would imagine that the risk is low...But as with all things, there comes a certainl level of risk.

Is there a cure? Well, you have been refered to an EP. I'm sure that he will suggest an EP Study. During this study, they will be able to determine where in your heart the arrhythmia is originating from. If is a simple garden variety form of SVT, than an ablation of that area could cure you of the problem. Success rates from the procedure are in around the 98% range. As for the PVC's this is a seperate procedure in of itself.

The SVT is in the upper 2 chambers of the heart where as the PVC's and short runs of VT are in the lower 2 chambers. Curing these is a seperate issue. Many Dr's will not offer a PVC ablation until the patient becomes severely symptomatic.

I hope that you find this helpful and further hope that you problems are easily remedied.:)
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Avatar_n_tn
Brooke,


Thanks for the quick response.

Here us the Interpretation Summary of the Echocardiogram and Nuclear Stress Test. I have no idea what this means and my Cardiologist basically just said my heart is normal. Any further remarks would be helpful.  Incidentally, during the 24 hour Holter I had Supraventicular Ectopy 27.9% of the time or 24,608 beats.

1.  Left ventricle is hyperdynamic. No evidence for left ventricular outflow gradient
2.  Mild concentric left ventricular hypertorphy.  Left ventricular wall motion and left ventricular ejection fraction normal  Ejection Fraction >55%
3.   Mild biartrial enlargment
4. No valvular aortic stenosis
5.  Dopplers:  There is mild mitral regurgitation


Here is the conclusion from the Exercise Stress Nuclear Test.

Abnormal exercise stress test, at 13 mets, EKG difficult to interpret secondary to baseline artifact, probably false positive.  Duke score 8

Perfusion scan negative for ischemia
Gated SPECT study shows post stress LVEF was 47% Moderate LV dilation , mild global hypokinesis

What is a Duke Score?

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251395_tn?1395961265

Hello...

I'm sure it was nice to hear that your heart is fine, but it would have been more helpful if your results were explained to you...in Layman's terms.

Echo results
1. Left ventricle is hyperdynamic... means that it is overactive -- beating too hard, pumping too hard and circulating blood at too rapid a rate
2. Mild concentric left ventricular hypertrophy...increased left ventricular mass and relative wall thickness. No left vetricular wall motion abnormalities with EF of 55%...Your heart is pumping normally.
3. Mild biatrial enlargement...The atria or upper chambers of your heart are mildly enlarged.  
4. No valvular aortic stenosis...there is no evidence of narrowing, stiffening, thickening, fusion or blockage of this valve.
5. Mild mitral regurgitation...occurs when the mitral valve doesn't close tightly and blood flows backward in the heart.

Duke Treadmill Score (DTS)=exercise time–(5 × ST deviation) - (4 × exercise angina), with 0=no angina during exercise, 1=nonlimiting angina, and 2=exercise-limiting angina.

The score typically ranges from –25 to +15.4
Low risk: > +5
Moderate risk: –10 to +4
High risk: < –11

Perfusion scan negative for ischemia...basically says there is no interuption of blood flow or oxygen in your heart.

Let me know if I made this easier to understand or confused you further:)

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Avatar_n_tn
Thanks so much for the interpretation of the technical terms.  This translation is very helpful.  Next step will be to see the exercise physiologist next Wednesday.  
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251395_tn?1395961265
The best of luck to you! Please let us know how you make out:)
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Avatar_n_tn
I visited the Electro-physiologist yesterday and was told that I have excess electrical activity and beats originating in the Atria and this activity is the precursor to Atrial Fibrillation.  Also I was advised to avoid stressful exercise as this would accelerate the progress toward A-Fib.  Is that correct?

The good news is that 9 seconds of the Holter waveforms during heavy exercise that were interrupted as V- Tac are acutally A-Fib (300 beats/min) that I was able to recover from.  I assume his fear is that I would go into to this an not recover.  However, I am not sure what is considered heavy exercise and for now I have assumed it would be sustained efforts over 155 beats/min.  This is my lactate threshold.  

The EP is starting me with drugs that are supposedly mild with minimum side effects .  This includes Rythmol SR 225 MG twice per day and Metoprolol Succer 25 MG taeth once per day.  Any idea what these are?  I was told that I am a poor candidate for "BETA Blockers" since my resting heart rate is so low ( 42 to 46).  Another concern from the visit is that I was told I will never recover from this (without ablation) and will need to take drugs for the rest of my life.   There must be some protocol in the medical community where drugs are always the fist approach.  Also, I was told that my condition has an 80% success rate with Ablation as apposed to others that are around 98%.      

Another bit of good news is that I was told by another doctor who reviewed all my test results that I am in no more risk of sudden death due to the onset of this Arrhythmia than the day before it all began.  

Happy Thanksgiving!

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251395_tn?1395961265
Hello...

Yes, I was told the same thing by my EP. I have not tempted fate with strenuous exercise since. I didn't want to find out for myself, I just trusted what he told me.

Rythmol SR (propafenone hydrochloride) is an antiarrhythmic drug and  Metoprolol Succinate extended-release Beta blocker that is formulated to provide a controlled and predictable release of metoprolol for once-daily administration.

Misinterpreted V-Tach was most likely related to Atrial Fib with aberent conduction to the ventricles. It's good that it terminated by itself.

It is true, unfortunately, that this can only be cured by ablation. Ablation is not a first line approach. They usually see how well you tolerate the meds. It is when medication fails, either not keeping you in NSR or side effects from meds are intolerable, that they consider you a candidate for ablation.

While Afib is not considered a life threatening arrhythmia, the risk of stroke is quite high. Did the EP mention anticoagulation therepy such as Coumadin (Warfarin) or antiplatelet drug like Aspirin?

Thanks for letting me know how you made out.

Happy Thanksgiving to you too!
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Avatar_n_tn
Hi,
  
I am 27 years old and have been in the hospital since Tuesday.  They say that I have PSVT but they are still going to run more tests to be 100% sure.  

After reading other stories about PSVT I can't help but notice that mine are slightly different.  My episodes can last several hours and the symptoms never completely go away. I have tingling in my limbs, my head feels lots of pressure, my eyes and ears burn along with the typical feelings that go along with PSVT.  

All my tests came back fine except they can't explain the increase and decrease in my pulse rate.  I am a ballet dancer and very healthy.  I'm not worried about this but I was wondering if you have ever heard of symptoms like this.

Thanks for listening-  Nicole
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251395_tn?1395961265
Hi Nicole...

Paroxysmal supraventricular (atrial) tachycardia is a regular, fast (160 to 220 beats per minute) heart rate that begins and ends suddenly and originates in heart tissue other than that in the ventricles.

Most people have uncomfortable palpations, shortness of breath, and chest pain.
Episodes can often be stopped by maneuvers that stimulate the vagus nerve, which slows the heart rate.
Sometimes, people are given drugs like adeonosine to stop the episode.

Paroxysmal supraventricular tachycardia is most common among young people and is more unpleasant than dangerous. It may occur during vigorous exercise.

Paroxysmal supraventricular tachycardia may be triggered by a (PAC) premature heartbeat that repeatedly activates the heart at a fast rate. This repeated, rapid activation may be caused by several abnormalities. There may be two electrical pathways in the atrioventricular node (an arrhythmia called AVNRT atrioventricular nodal reentrant supraventricular tachycardia). There may be an abnormal electrical pathway between the atria and the ventricles (an arrhythmia called AVRT atrioventricular reciprocating supraventricular tachycardia). Much less commonly, the atria may generate abnormal rapid or circling impulses (an arrhythmia called true PAT paroxysmal atrial tachycardia).

The fast heart rate tends to begin and end suddenly and may last from a few minutes to many hours. It is almost always experienced as an uncomfortable palpitation. It is often associated with other symptoms, such as weakness, light-headedness, shortness of breath, and chest pain. Usually, the heart is otherwise normal. The doctor confirms the diagnosis by doing an electrocardiogram.

Have they done or mentioned doing an EP Study? Have they mnetioned the possibility of IST (Innapropriate Sinus Tachycardia) ? Regarding the numbness in your limbs...this could be from decreased cardiac output secondary to the PSVT...meaning that when your heart is in SVT, the amount of blood being pumped from your heart to the rest of your body is decreased.

I wish I could give you more info. What hospital are you currently in?
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