SVT perhaps

[Llyons22]

Hi

I am a 38 year old female. I started having PVCs at 33 and at that time I had a complete workup ie echo, stress test, holter monitor, etc. It was found that my heart was fine .Thist year, the PVCs got more frequent.  In  June of this year, I was required to three kenalog epidurals for lumbar disc herniations. The first went fine with the exception of a pounding heart for three days following.   Called my back doctor who stated that he had never heard of this and offered me anxiety meds which I declined. During the second epidural I had a brief episode of tachycardia (rate 160 for a few mins). This occurred while  I was heavily sedated. The doctor again stated that it must be anxiety. Again heart pounded for three days post injection.  I went to the cardiologist who I had seen before. He did an EKG which appeared normal except for a mildly shortened PR interval, he ordered   asingle IV dose of lopressor to be taken prior to the third epidural . That went without incident except for the pounding heart for three days following. In early July, I began feeling run down , to the point of barely being able to get out of bed. Thought it was a virus . Then two weeks ago still feeling really run down, I had two episodes of dizziness , chest tightness and very rapid heartbeat (in excess of 160). First was precipitated by exercise , the second occured at rest. Went back to the cardiologist and he prescribed  atenolol 25 mg daily. I feel great now, energy is back, heart is slow and normal and no PVCs. My question (finally) is the following. My doctor did not order any other tests. Is it necessary to determine the type of arrhythmia or was the finding of the shortened PR interval  and the fact that the beta blocker is working enough?? Also, should I have another stress test or other tests or  is it assumed that if my heart was normal 5 years ago, then it still is. I really appreciate any insight into this


Leah

[Michael J. McWilliams, M.D.]

Hi Leah,
My doctor did not order any other tests. Is it necessary to determine the type of arrhythmia or was the finding of the shortened PR interval  and the fact that the beta blocker is working enough??

One of the most common causes of a short PR interval is a normal variant.  There are some SVTs associated with short PR but they are usually associated with other ekg findings.  If the fast heart rate can be controlled with a medication that is well tolerated, this is the most appropriate therapy.  To be honest, 99 times out of 100, a tachycardia in the setting of procedure is anxiety -- this is completely normal.  It would be a bonus if they have an EKG rhythm strip of the fast heart rate, especially the initiation and termination points if there is one.  If there isn't a true initiation or termination, that makes it more likely to be anxiety.

It sounds like your doctor is doing the right things.  If it keeps happening, it is worth repeating the monitoring tests at the least.  It sounds like the beta blocker is working though.

I hope this helps.  Good luck and thanks for posting.

[Llyons22]

Thanks so much for the reply!!!

[anacyde]

I just had to comment here.  I had Kenalog injections for post-surgical keloid scars in March 2006.  Weeks of incessant PACs and PSVT ensued.  I was then diagnosed with a pregnancy-related heart enlargement (had a baby couple months earlier).  The palpitations were more than likely a result of the heart problem I didn't yet know I had.  I'm still afraid to go back for the remainder of the Kenalog treatments I need for the scars, even though I've been reassured a number of times one did not cause the other.  I think we can really do a number on ourselves psychologically when two things coincide.  I went back to my dermatologist just for a check up, no shots, and I got the PACs terribly that evening.  If I had done the Kenlalog shots, I would have blamed them of course.  I now have proof of what my own fear can do in terms of my heart rate and the premature beats.

Hope you feel better soon :)

[Llyons22]

Honestly I am almost positive the shots did not cause the arrhythmia. It was probably just coincidence that the first real problem , stress induced or not, occured during the injection. The "episodes"  that followed were however not stress related. In fact, I believed at the time that the elevated heart rate and other problems were secondary to something else..like a virus or something. Knowing all that however, I must admit that if I need another set of kenalog shots, I probably will not do it because no matter how much I talk myself out of it, I will be convinced there will be problems and therefore there probably will be. I agree we really can scare ourselves almost to death. Hope that everything works out Ok for you

Thanks for your help