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Superventricular Tachycardia? Or something else?

Hi. I am a 22 year old living in NSW in Australia. I have no previous health history, I consume no caffenated beverages and I am not overweight. My BMI is 24.5.

About three months ago i began having palpitaions associated with shortness of breath. I am an ED registered nurse and was working in the department at the time. I was given an ECG which showed sinus tachycardia, at a rate of about 130.

I went to see a cardiologist who thought it was propbably just a bout of mild dehydration and sent me on my eay. However, a week later I was sitting in front of my heater when my pulse rate jumped to 200 bpm, associated with shortness of breath, dizziness and palpitations. When I went to the ED, as soon as I sat on the bed my heart rate dropped to about 130. The ED doctor said the ECG caught me in sinus tachy, but it sounded very much like SVT. I was admitted to CCU and put on Atenolol 50 mg once daily. When I went back to the cardiologist he organised for me to go for an electrophysiology (EP) study, and ordered me to go off my atenolol in preparation for that.

Within a week, I was back at work with severe palpitations. I was put in resuscitation and given an ECG. Again, as soon as i laid down flat my heart rate dropped from 170 to 130 and my ECG showed sinus tachy. However (and I don't remember this part) at one stage I sat up to talk to my colleagues. The heart monitor showed my heart rate immediately jumped from 130 to 160, became irregular, lost its P waves, and inverted. I apparently became dizzy and passed out. As soon as they laid me flat my rhythm became normal again (sinus tachy).

I am now back on my atenolol but it is not working like it used to. I was on night shift again last night when the palpitations occurs. When connected to the monitor and standing, the monitor showed i was in SVT at a rate of 155 bpm. As soon as i laid down on the bed, the SVT dissappeared and sinus tachy came back. I also developed chest pain last night, aching in the middle of my chest, into my left arm and my throat. We connected the ECG and then i stood up. I immediately felt like i was about to pass out.

Because I was standing, the ECG readings are a little shoddy. But the results are as follows, as recorded from the ECG:

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Ectopic atrial or superventricular tachycardia, rate 144
Premature complex, uncertain mechanism
Borderline lateral Q waves
Borderline R wave progression, anterior leads
Abnormal T, consider ischemia, inferior leads
------

Because the SVT dissapears when i lie down, I was unable to be given adenosine. When lying down my ECG just shows sinus arrythmia, rate 75-150. There are some T wave inversions also on this ECG.

My third ECG was recorded when I had chest pain. The results are as follows:

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Sinus tachycardia, rate 133
Right atrial abnormality, consider LAA
Abnormal T, probable ischemia, inferior leads
------

The girls did a troponin on me which was negative (<0.03) but we did not wait 6 hours until after the pain to repeat the trop. I still have an aching, dull pain in the centre of my chest.

Now I know this has been long winded but i'm at the end of my rope. I'm an RN and even I don't understand whats going on. My doctor doesnt know whats going on. It has taken them two months to schedule my EP study, which I think is far too long for a 22 year old with no previous cardiac history. Does anyone else have these symptoms when they sit/stand up or change position? Is it normal to have ischaemia on your leads? Will this EP help me at all? I just need to know theres other people out there who have the same thing. Please help! Especially any doctors out there who have an ED/Cardiology background!!!!!!!!!!!!!!!!!

Kas
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Avatar universal
Thanks you guys for reassuring me. I'm going for my EP in a week and while it sounds morbid, I hope they find something because these symptoms are getting frustrating. :-p

Unlike you,  ptadvoc8, valsalva's are not always able to revert me. I believe that this is because I am still not 100% pro at doing them. I'm glad that someone else is able to revert their SVT by lying down - this always seems to be the case with me. But, if I am at work, which is when it normally happens as I do a lot of night shifts, I can't spend a lot of time lying down, and when I stand and continue working, they just come back. I

I'm going to ask my cardiologist about POTS as my symptoms do seem reminicent of that syndrome. Also, I'm a bit confused as to why they haven't done a stress test on me, as when I go to the gym and do moderate to strenous excericse, my pulse skyrockets to about 220 bpm. I understand that stress tests are usually unable to diagnose SVT, but since my pulse does jump up when I excerise, why haven't they done one?

I guess I'm just looking for answers... Cardiologists and very decretive about things. :-p And I get more info than most people because I'm a nurse. :-p

Anyways, any information or tips you can offer me on reverting from SVT/bringing down my heart rate would be appreciated. Thanks heaps!

Kas
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Avatar universal
In addition to POTS, which seems like something worth looking into as mentioned above (and which some research suggests is more common than previously believed), there are some less common types of "hidden" accessory pathway arrhythmias (like "hidden" WPW) that can present in a similar fashion -- although it would seem unlikely that these would be the cause of your symptoms as they are not that common. In these conditions, the ECG can appear absolutely normal (no Delta waves, no short intervals, no flattened or inverted waves) unless the patient is currently experiencing SVT at the time of the ECG tracing. In addition, when looking at the ECG tracings from these patients during SVT, it can be difficult to actually detect the specific problem as they appear "anamolous" or "aberrant".

I have WPW that presents with an always abnormal ECG reading so my case is different from yours, but I did want to let you know that when I have episodes of SVT the ECG is pretty wonky looking (aberrant and anamolous) and automatically suggests such things as "check for ischemia" or "suggestive of ventricular injury" -- none of which I have ever been documented to have, and all of which go away when I revert to NSR. If it is any consolation, I have over 3 decades of experiences like this and am still going strong...

When standing most people's heart rate increases -- in those with POTS, certain arrhythmias and some other conditions, the rate may increase substantially AND may result in SVT that may then abate when lying prone. In fact, THE major way I STOP my SVT is to lay down flat on my back -- this works for me 98% of the time -- and if I add a valsalva maneuver to my prone position, it works (eventually!) 100% of the time to convert to NSR. Also, once I have been in SVT, my heart rate, in NSR, is elevated for awhile and I frequently experience bouts of chest pain, both during SVT and immediately afterward.

So, while I have no idea what your situation is, I just wanted you to know I have experienced some similarities with what you describe and over the years I have been given a long list of diagnosis. I think the most important thing is that if YOU feel uncomfortable, anxious or ill with this, that you continue to seek care and ask questions until you are feeling physically and emotionally better. As you will learn by reading through this forum, most episodes seem to be more frustrating and anxiety provoking than life threatening, but many of us have found we often need to assert ourselves with our medical providers to get to a point where we have a diagnosis that fits, treatment that works and/or just learn to live with it. Good luck!
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187666 tn?1331173345
Look up POTS, Postural Orthostatic Tachycardia Syndrome. I do believe they even have their own site for that. Your symptoms sound similar to this.
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