What evaluation for chest pain, nausea after SPVT?

[villandra]

I have steadily worsening paroxysmal supraventricular tachycardia.   Lately I've been having right sided chest pain with bouts, both short and long, usually just after, and sometimes by itself.

Today while riding my bike not all that hard, but a little out of breath, I had one of my better attacks.  The fact that I was already out of breath and have asthma aggravated it.   It's usually hard to breathe or impossible to breathe fast enough during these attacks.   After the attack the right side of my chest ached and the pain often spread down my upper arm, and my stomach felt queasy, for several hours.   Also when I first got up to walk over to the ambulance, my legs seemed to be made out of lead.   When I got out at the hospital my legs still weren't steady.  None of this is normal for a bout of PSVT.

First, what should they actually have done about this in the ER?   They spent two hours trying hard to pretend I made up the whole thing and also made up the fact that I have PSVT, which was diagnosed by a cardiologist whose identity they didn't even care to know.  

I did finally manage to get them to take it seriously enough to admit me and a cardiologist is supposed to see me tomorrow.  What workup should I expect now?

I have already had an echocardiogram, which was normal, and a stress test, which was carefully done in such a way that I was never allowed to even get out of breath - both normal.  

I understand that the causes of PSVT are an electrical abnormality, and ischemia.   I know that the procedure to look for an electrical abnormality is the same procedure that would fix it.    What is/are the procedures to look for a blocked blood vessel, or, probably more ephemeral, a spastic blood vessel?    

Thanks!

Dora

[Artaud]

Great news about passing the Stress Echo. See below on a comparison of Nuclear Stress and Stress Echo Testing. But I would remain vigilant. I'm curious, have you considered what michellepetkus had to say. Has anyone considered the PSVT.

In a gentler way than Tom (but the weather service has taken to using explicit severe weather warnings, such as for tornados, since they motivate people to action) women often present heart symptoms in a different manner than men. Perhaps a cardiologist that specializes in women, or a woman cardiologist.

http://usgovinfo.about.com/cs/healthmedical/a/womensami.htm

http://www.kevinmd.com/blog/2011/03/restricting-nuclear-cardiac-stress-testing-favor-stress-echocardiography.html

[tom_h]

"They did an echo stress test.   I passed it with flying colors."

Yes, and there are marathon runners who drop dead every day.  Pain during or after an SVT event is not normal.  You're getting a warning here.  Take heed.....

[MichelleP_3811]

As Artuad stated, ERs are designed to treat immediate issues.  Their goal is to keep you alive, not diagnose.  At the time you presented you were not in cardiac distress based on the EKG results so you took low priority.  If you were having a heart event it would have showed up on the EKG.  So ERs really aren't the place to go for diagnosis.  You might want to consider setting up some time with a cardiologist to get a full workup of your heart though it sounds like you have had a few tests and all appears normal.  SVT is hard on the heart so it is not uncommon for there to be some residual issues after an episode.  It is a muscle and beating faster than normal can stress it out.  But if your heart is structurally normal it will heal in time.  It is just best to take it slow until you feel better.  

So you state you were diagnosed with psvt.  What treatment options were presented to you?  Were you given the option to try ablation?  Were you told what type of svt you possibly had?  Afib is a bit more serious then some of the others.  When you get an episode does it start and stop in one beat?  What rate are you at?  Ultimately working out a game plan with your cardiologist is your best bet at managing and/or curing your svt.  Best of luck.  

[villandra]

Thanks, Artaud.

They did an echo stress test.   I passed it with flying colors.

Would an angiogram yield more information about the health of surrounding blood vessels?    If something were wrong with them that was affected by exercise, would it most likely have shown up on the stress echogram?  

Is a spastic blood vessel as a cause of arrhythmia actually rare?

One thing that really concerned me is that, after I was delivered to the ER by an ambulance, they weren't in much of a hurry to do anything beyond an EKG.   They kept telling me they were going to do things and not doing them.   People with garden variety ER problems had as much priority as I did.   I later found out they looked at me and decided I "looked" like I wasn't having a critical problem.    A nurse asked me how I know I have PSTD; did I just decide that.   Noone ever asked if I had a cardiologist or his name.   Two hours later they finally ran cardiac enzymes and a CBC; don't know if they ever checked my electrolytes, and I'd been riding my bike on a hot day when this happened.  For the rest of the day I kept getting leg cramps.   Finally they did a chest X ray because I noticed that the protocol taped to the cabinet called for one, but the point was only to make sure I didn't have a lung problem and my heart was the correct size.  

I was specifically there on account of persisting chest pain, weakness and upset stomach.

The other two times I was taken to the other hospital system it was very different; they assumed it was a heart attack until proven otherwise.

Finally, three hours later, after getting my sister in on it, a different doctor took it seriously, and I was admitted and watched overnight and then they did an echo stress test the next day.

What should I specifically have expected?  I'm thinking this is one of them hospitals where a woman with a heart attack would be likely to die.

Dora

[Artaud]

A little material on PSVT from the National Institutes on Health.

http://www.nlm.nih.gov/medlineplus/ency/article/000183.htm

I'm not sure how frequently ischemia causes PSVT, but from reading through the link, Ischemia during an PSVT episode is a possibility (though the vast majority of PSVT patients this is not a consideration).

The addition of the pain sets warning flags, and a Nuclear Stress or Echo Stress would likely be warranted. I would have assumed that the Nuclear Stress was more conclusive, but have since read otherwise, both techniques yield similar results in most people and the Stress Echo has an added advantage of imaging blood flow and valves.

Either test would be aborted upon EKG indications of undue stress on the heart or the occurrence of certain rhythm disturbances. If ischemia is suspected, heart cath would subsequently be indicated, an angiogram of the heart's vessels, to verify or rule out coronary artery disease.

Hospital E.R.s are set up to make sure you're stable, not to make minute determinations, and they see a wealth of rhythm disturbances. By this time you likely already have your answers, I believe you were scheduled to see the cardiologist, I hope you let us know how it went.