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Why do I go into SVT when yawning?
I've had episodes of tachycardia on and off for about 14 years now. First I was told I had a benign murmur and when I had my first child I was told it was Mitral Valve Prolapse (both times required a 24hr holter). They tried putting me on beta-blockers but it wasn't helpful so I remained off any meds for years. Last year however, I was reaching for a gallon of water off the floor when suddenly I felt my heart start to flutter in 2 different locations (front of chest and side of ribs) uncontrollably. I tried my usual coughing, cold water on my face, bending, pushing, etc. and was not able to stop the palpitations. At that point I started to freak out and feel my left arm go numb in between episodes of feeling faint. I had my husband rush me to the emergency room thinking I was having a heart attack this time and not my normal tachycardia. When I got to the hospital, I had a heart rate of 260bpm. About 15 doctors and nurses rushed into the room and started warming up the shock paddles all while nurses scurried to put leads on me and do an ekg. They kept asking me if I had taken anything and were expecting me to "crash" at any moment. I never loss consciousness and was given Adenosine instead through IV which stopped my heart for a few seconds. I was admitted for 5 days on the cardiac floor for monitoring and was in the process of getting a transfer to a bigger well equipped hospital for an ablation when I decided not to go that route. I was discharged on Xanax and Lopressor XR. I took that for a while but the Lopressor lowers my blood pressure too much and since then had to stop taking it. I've cut all caffeine out of my diet and started excising more and have been symptom free for about 7 months now but last night when I was laying in bed, I got this strong urge to yawn. When I yawned, my heart went into SVT and I almost fainted. I was in SVT for about 3-5 minutes before I was able to stop it by pressing and releasing on the main vein on the left side of my neck. I am pretty scared over this and after I was back on normal rhythm my body shook uncontrollably as if I was freezing cold. And I felt a little loopy for a few hours after. Has this happened to anyone else before?? Both my cardiologist and electro physiologist say that my heart is in great shape and I should consider having an ablation which has a 95% success rate, problem is I am terrified. My normal heart rate is between 110-115, anything lower than that and I feel like I will pass out but according to all doctors that is already tachycardia. The highest I've gone is 260. I've past out a few times before, usually when my heart is fluttering (quivering) but regain consciousness quick. I'd appreciate all feedback and suggestions as I am terrified at what will happen next. Thank you.
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your reply was extremely helpful!! Glad to know there are others who experience the same things I experience and who can provide me with great information. I will look into the ablation as I cannot deal with these "attacks" much longer. I find myself constantly paying attention to my heartbeat and wondering when will be the next time my heart decides to skip a beat and act crazy but again, thanks!!
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Essentially you have an extra muscle fiber in your heart, likely into your avnode with how high the heart rate is, that caused the signal to get caught in a loop. If it is indeed going into the avnode it is called avnrt. It is the most common type and very easy to correct with ablation with high success rates and extremely low complication rates. The biggest concern is the need for a pacemaker but that is rare for that to occur. The complication rate is something like 1 or 2 percent where the complication rate for something like appendicitis is 15 percent. So an ablation has good odds.
This said, my cardiologist basically said it was my choice to ablate or not. That technically I was in no danger but from my own experience having had the svt my whole life it was getting worse towards the end and I was having daily symptoms of an irritated heart so I opted for the ablation 3 and a half years ago and have not had an episode since. I still get some ectopic beats which actually help contribute to falling into svt but the svt has been cured.
Cutting caffeine is good and exercise is excellent for helping you tolerate the episodes better but doing it or even taking meds for it will never keep you from ever having it again. The only sure fire cure is an ablation. This said, you do sound to have rare episodes and an ablation with only rare episodes can be difficult. The ep needs to be able to induce an episode to know where to ablate and if a person is only having rare episodes sometimes they can't get it going and in the states it is an expensive procedure. If you are able to stop the episode on your own you may be able to minimize any stress on your heart for the long term but you may get to a point like me where you were having an episode every week and it was starting to take a toll on the well being of your heart. At that point you might want to consider an ablation. I was terrified to do it but it wound up being a piece of cake and not really all that scary. I have had to full on abdominal surgeries and they were way worse than the ablation. You can read about mine if you click on my name and read my journal entry.
Anyways, in your case I wouldn't necessarily run to do an ablation but do be mindful of stopping the episodes as soon as you can and exercising will help condition your heart to help you tolerate the episodes better when they do happen and you should be fine to wait until it feels right to do the ablation. As for why it happened when you yawned. I can't say for sure but likely the yawn triggered an ectopic beat that caused a short pause in the triggering of your next heart beat which allowed the secondary pathway (extra heart muscle tissue) into the avnode to reach the center of the node where it wound up going out the main pathway causing it to loop on itself. You can look up avnrt to understand the physical dynamics of what is happening but very often the disruption of an ectopic beat (a pvc or pac) gives the svt a chance to complete a circuit is usually how the svt gets triggered especially in instances of avnrt.
Anyways the exercising will help your heart but if you do tend to low bp do make sure you drink lots of water as you exercise and do not exercise if you are overly hungry or it could cause a dangerous dip in your bp. But other than that it could also help your higher than normal heart rate. I am not sure if it is typical but I had a very high normal heart rate but once I got the ablation and got persistent with my exercising it came down. Your body adjusts slowly so you do not have to fear low bp. You actually may have low bp issues because of the higher heart rate. In any event exercising is really good for your heart but if you happen to get an episode while doing it stop immediately and tend to the svt.
I do kind of wish doctors weren't so complacent about svt especially when it becomes more frequent but in instances where it happens on rare occasions there isn't a need to rush into anything so take your time to sort it all out in your head and do what feels right to you, It's not like you can't do an ablation at a later date so long as you take your condition seriously and mange it properly you should be just fine. Take care.