SVT and vtach

[steve]

Hi!  I am a 33 year old male that was diagnosed with SVT when I was about 15 years old.  This was after going to the ER several times with a heart rate of about 200.  I was told it was benign and not to worry about it.  When i was about 25 i was having more episodes and went in for further evaluation.  After a stress test and echo i was told everythg was ok, but was put on calan 240 SR.  One thing that was never caught on tape was the fluttering I sometimes get before the fast hearet rate.  It lasts 5 or 10 minutes, and now I believe it may be atrial fib.  Could it be? Whenever it happens i know the fast heart rate is coming. 02/28/00 I had a svt episode and later felt short of breath.  Could have been anxiety.  Went to ER and they did EKG, blood work, stress test with the dye, and echo.  All was normal but i have been sent to EP doctor for possible RF abalation.  I started wearing king of hearts monitor 2 weeks ago and went off calan to get episode on tape.  Well, now they have caught very brief episode of atrial fib, and 5 beat episode of ventricular tach.  I was in a panic over this after the nurse told me it was serious.  EP doctor called me back and said "i don't see a problem even though the brief episode appears to have started from the lower chambers of your heart".  He said keep wearing the monitor for another two weeks and come back in to discuss the ablation.

Could I have heart disease and the tests I had did not show it?

I thought v tach, even unsustained, meant heart disease?

Should I get a second opinion now?

EP doctor said i could keep running my 15 miles per week.  Could this be dangerous?

[steve]

JUST WANT YOU TO KNOW THAT I THANK GOD EVERYDAY FOR HAVING AN ABLATION. ALL MY SYMPTOMS ARE GONE AFETR YEARS OF HAVING THE SAME PROBLEM. I WISH YOU LUCK WITH EVERYTHING

[Eastwind Sailor]

My wife recently had several AF epiosdes and was hospitalized 4 times, each time trying to select a medicine to address the problem. After doing research on the web, I asked our Doctor to do some research on Neurogenic AF caused by vagal stimulation. Good guy that he is he found a paper written by a Dr. Erika N. Ringdahl at the University of Missouri (www.archfammed.com). She perfectly described my wifes condition (vagally mediated AF)which lead us to the to the conclusion that all the medicines, Toperal, Sotalol,and Rythmol, that she had been administered was counter productive and was stimulating the AF occurences. Based on her article our Doctor prescribed an initial dose of 100mg of Norpace, which has absolutely corrected the problem. My wife always experinced the AF after her noon meal and she always reconverted in the morning. Her episodes started with a tightness in the throat, missed beats and then full AF. Nice to have a Doctor who listens to his patients. Hope this helps someone.

[to Jen about pvc's]

Hi Steve,
Good Luck with your ablation, and good health to you!

Cheryl

[Steve back to Cheryl]

Hi Cheryl

Went to EP doctor for follow up appointment.  I will be having RF abalation soon, probably in the next 3 weeks.  He seems confident he can find the trouble spot, and look for any others there may be.  You are right, the atrial fib is more disturbing than the fast heart rate.  I think once I had it for 30 minutes before the fast heart rate started.  As far as the v tach, it just felt like the svt was starting to me, but only lasted 5 beats.  Sent the recording to a nurse she made it sound like I was in serious trouble.  My doctor told me I am fine, and he will again talk to them about scaring people.  Echo and stress test normal.  I have been off Calan now for almost 4 weeks, I feel better than ever.  I am up to 20 miles per week running, very few PVC's or PAC's.  I hope I never have to take these meds again because I think the side effects are worse than the svt.    Steve

[Cheryl]

Hi Steve,

     I have SVT and will have a few seconds of AFib right before.  Sometimes I will have a few seconds of AFib without the SVT.  It's really scary, but doesn't happen very often.  I think the afib is much worse feeling than the svt.  I've only had it happen for at the most a couple of minutes.  Don't know if I could stand it for longer than that!  I have taken inderal which made me very mellow, too mellow actually.  I now take sectral which is much better for some reason.  I rarely have any problems anymore, and don't seem to have any side effects from the beta blocker. (a little less exercise tolerance maybe, but I'm not a big exerciser anyway) Hope you find a good treatment plan.  Does vtach feel like svt?  I'm assuming it's kind of similar only coming from the ventricles instead of above the ventricles?

Cheryl

[Greg]

honestly, i dont know if ablation would help or not....definately if the vagal stuff was triggering a reentry type of atrial fib...it would help. ive found also that sleep plays an important role. too much is never enough! beta blockers
have done some good for me...but the side effects are terrible. there is no work being done anywhere exploring this connection that i know that. i am so tired of this, that i just have come to accept that one day im going to keel over and die from it, so i live one day at a time anymore. hell, the way is see it, if cardiac arrest dosent get me, ill throw a clot and have a stroke!!!

[mrsally]

Greg-I also get mucho PVC's after a large meal and know the vegal nerve the culprit. I've gotten out of arrhythymias by the valsalva maneuver many times - my very own cardioversion! I also have embarrassingly passed out in restaurants! Does radio ablation help things that are caused from a vegal response?

[Greg]

i firmly believe that when in atrial fib. (whith little or no ventricular response), that anything that disturbs the vagal nerve will throw you into svt...(i know this to be true in my case)....its the atrial fib that is the culpret. most times from what i understand, svt will start as soon as the a-fib. but for some people (especially those of us on a beta blocker) there will be a subdued reaction or no reaction between the atria and ventricals. so although you are in afib. your pulse will remain normal or just slightly elevated. either way, it is "uncomforting" to say the least. i am up for a EP study here soon and my doctor sees me as some kind of freak because sometimes i can trigger my svt on demand!!! but, then again...most doctors are unwilling to accept the connection between the vagus nerve and irregular hearbeats, because its not well documented. small world, small minds i guess...they say its harmless, but if more doctors knew the feeling of turning white and passing out in a resturant after eating a large meal, i believe there would be more "research"....

[Heather Archibald]

Hi I wonder why all the doctors has this atidude that the vagal nereve is not involved. I had a laporoscopy operation.When I woke I had pain down the left side of my body.I had very bad pains in my abdomin. I also had a strange fluttering feeling in the left side of my chest.I was told this was gas.I was diagnosed with a bowel disease which is gone now. I have just found out the fluttering in my chest is in fact a heart murmur. I have shortness of breath very tired when I try to do anything. I keep passing out like you guys. I was taken off the treadmill test at 2mins 33secs. Due to a very fast heart rate. I was told it was a inocent heart murmur.I am left in this condition. with everyone saying thers no conection with the vagl nerve, abdomen and heart murmur.Just to top it all, I have started to take like an electric shock feeling going through my body, then I faint or feel really dizzy. I think there is a conection to all of this via the vagal nerve not working the electric side of the heart. I think its a problem in the outflow track.but there is a connection.
Heather

[aaron]

Mine starts the same way too.  I get PVC's first or a really irregular heartbeat and then it goes into SVT.  The irregular beats usually only last for about 10 to 15 seconds before it happens.  I had an EP study/ablation done 2 months ago.  Because the SVT was originating from the sinus node both my doctor and myself decided not to ablate it because of the risk in it's origin.  I would recommend seeing another Dr. to be sure.  Good luck.

[steve]

hi greg

well, i will tell you the thing that seems to set my heart off is bending over quickly, sudden jerking motion, swinging a golf club or baseball bat. When I was younger smoking a certian something, if you know what I mean, set it off everytime. Now I am not that stupid.  Sometimes it just happens for no reason.  The SVT I have been aware of for many years, and now I think what sometimes happens before the svt atrial fib.  When I take my medicine the atrial fib never happens, only the svt does.  This v tach which has now been recorded, I don't know if it is new or just new.  I do know that I need to get a handle on this thing soon

[Greg]

steve,
i have the exact same symptoms to the T...even the fluttering feeling before "going in" to v tach. it could be atrial fib, (still no proof in my case)....have you ever noticed that the occurances are linked to a vagal cause? for example, heartburn, irritable bowl or maybe just bending over or coughing?

[CCF CARDIO MD JMF]

Dear Steve,

Your case sounds complex and would recommend the following.  It is very common for people to have SVT's and once these become symptomatic it is often the case that RF ablation is recommended.  I would recommend that you follow up on whether this is appropriate in your case.

As far as the atrial fibrillation and VT, in the setting of a structurally normal heart ( which seems to be your case) cardiologist may only prescribe a beta blocker to help reduce heart rate and decrease the frequency of these extra beats.

I would probalby recommend a second opinion in your case to review your data and consider your alternatives for these conditions.  Please feel free to contact CCF.  I would highly recommend Dr. Bruce Wilkoff if you require a second opinion.