What is the difference between inappropriate sinus tachycardia and supraventricular tachycardia?
I am 68 yrs old and have been diagnosed with inappropriate sinus tachycardia; am being treated with small amount of Bystolic. My 40 year old daughter has just been diagnosed with SVT and is going to be having an oblation in a few days. What is the difference between these two? Our symptoms are similar, but hers are far more severe.
It's a good question. Inappropriate sinus tachycardia (and "appropriate" sinus tachycardia for that matter) is a supraventricular tachycardia. Supraventricular tachycardia is an expression used for all tachycardias that originate above the ventricles (there are a lot of them and most of them are benign). The list includes:
- Atrial ectopic tachycardia (unifocal and multifocal) - "series" of PACs
- AV nodal reentrant tachycardia
- AV reentrant tachycardia (WPW syndrome)
- Sinus tachycardia (physiological, inappropriate or caused by disease)
- Sinus node reentrant tachycardia (uncommon, variant of sinus tachycardia)
- Junctional ectopic tachycardia - "series" of PJCs (uncommon)
- Atrial flutter and fibrillation with rapid ventricular response
If she is going to have an ablation, sinus tachycardia is unlikely and the most likely causes are AV nodal reentry tachycardia, AV reentry tachycardia or atrial tachycardia.
Inappropriate sinus tachycardia will often give extreme heart rate response to easy exercise or movement. It's rarely a heart disease, it's more an autonomic imbalance. Other supraventricular tachycardias are either caused by an irritable focus in the upper chambers releasing impulses at high frequency, or an extra pathway somewhere in the upper chambers or around the AV node, or an extra pathway connecting the upper and lower chambers. They all can be cured with ablation.
I hope her ablation will be successful! Good luck to you both!
Supraventricular Tachycardia refers to any tachycardia that is not ventricular in origin. This can include physiological sinus tachycardia which can be a normal reaction to stress and a variety of non-cardiac conditions such as fever and hyperthyroidism. In the widest useful sense supraventricular tachycardia includes abnormal sinus tachycardia, ectopic atrial tachycardia, atrial fibrillation/atrial flutter and junctional tachycardia.
Often, however, in a clinical setting, SVT is used practically as a synonym for paroxysmal supraventricular tachycardia (PSVT). This term refers to those SVTs that have a sudden, almost immediate onset and are regular. A person experiencing PSVT may feel their heart rate go from 60 to 200 beats per minute instantaneously, often in response to a quick movement such as picking something up from the floor. Because physiological sinus tachycardias has a gradual (i.e. non-immediate) onset and AF is usually obviously irregular they are excluded from the PSVT category. PSVTs are most commonly AV nodal reentrant tachycardias or part of Wolff-Parkinson-White syndrome (WPW) which may be "concealed", i.e. not evident on the resting ECG.
Inappropriate sinus tachycardia or IST, is an uncommon type of cardiac arrhythmia, but falls within the category of supraventricular tachycardia (SVT). The mechanism and primary etiology of Inappropriate sinus tachycardia is not fully understood. The mechanism of the arrhythmia primarily involves the sinus node and peri-nodal tissue and does not require the AV node for maintenance. Treatments in the form of drug therapy or catheter ablation are available, although it is currently difficult to treat successfully. The primary difference with IST is the onset of an event isn't as sudden as in other forms of PSVT. Heart rate may be consistantly high with IST. With SVT, heart rates will be within normal limits until an event starts.
I hope that helps a little, and I wish your daughter good luck with her ABLATION. Afterwards, you may want to offer an oblation!
The procedure is relatively simple, but sound frigntening. I think all of us that had the procedure are a bit freaked out about it beforehand. Afterwards, we all sit around and talk about how easy it was. Please see my journal entries under my username if you'd like to read more about my ablationexperience
Tom, thanks so much for your easy-to-understand explanation about the difference in IST and SVT. My daughter's ABLATION, (thanks for your correction!), has been scheduled, and she is anxious to get it behind her. She's very strong and brave; takes thing in stride and doesn't seem at all concerned. She feels it will be successful, and I truly hope and pray she is right. My son is an anesthesiologist (who didn't help me at all with my medical spelling quiz!), and he has explained the procedure to us both. He explains it just as a typical physician would; "very interesting procedure". Y
Your explanation was excellent. Her episodes do come on suddenly, and otherwise her heart rate is normal. Mine are not really episodes. My heart rate is high all the time, and the Bystolic is doing a good job of bringing it down. In your opinion, in my case, would an ablation ever be indicated?
I would very much like to hear more about your ablation experience! I hope to hear from you before my daughter has hers. Will she be put to sleep? I haven't had an opportunity to speak at length with my son about this, because unfortunately, his mother in law has just been hospitalized with a brain tumor. When it rains, it pours. His time at the present is at the side of his lovely wife, who is being very strong, but needs him anyway.
I do so look forward to hearing back from you. And, again, thank you so very much.
Thank you so very much for such an excellent explanation regarding my question about the differences in SVT and IST. I feel I have a much better understanding of it now. I'll pass your information on to my daughter, as well. Her ablation is scheduled in the next few days, after a nuclear stress test, which at her age she has never experienced. She's having many new experiences!! Obviously, not all of them all that great!!
By the way, are you in the medical field? Your answer sounds as if you are.
As far as your daughter's upcoming EP procedure, I think it all depends on the physician. Mine asked me ahead of time, what kind of anesthesia I would prefer. In my case (WPW), he preferred general anenthesia (and so did I) and that's what I got. Other cases may require the patient to be lightly sedated, and there are others here on the forum that had no sedationat all. The puncture site is numbed with a local anesthetic, so the needle there is probably the worse pain you will experience. I've heard though that the burn is painful as is the trans-septal puncture, but since I was out, I don't really know for sure.
I have been diagnosed with Abnormal Inappropriate tachycardia syndrome, but the doctors at UTMB can not explane to me what causes it and how to combat the "feeling of running all the time". They have tried to treat it with various drugs. None of which seem to be helping.
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