six days of SVT's

[johnnyrocketman]

I'm a 63 yo male that just competed in the TransAm bike race. I was on day 10, and was resting comfortably in a hostel for the next couple days due to repairs on my bike and snow in the forecast.
I stopped riding Monday afternoon, and the following Tuesday morning, while resting comfortably in the lobby, my heart started converting between 60-160. I started timing them. It did this for the next six days often waking me up at night.
Anyway, back to the story.  I literally walked across the street to a medical clinic...W. Yellowstone...Tuesday afternoon an within two minutes they had called 911 and I was on my way for an 84 mile ambulance ride. My heart was converting all the way there in the range of 50-160 every few minutes. Thank God they got it on paper. Once admitted into the ER it continued to convert every few minutes. They released me three hours later after a chest x-ray and blood work I assume checking for electrolyte imbalances.
When I walked out of the hospital it was still converting back and forth from the 60's to 150's. They didn't seem that concerned but a talk w/attending physician strongly implied I should withdrawal from the race. I'd had minor rhythm issues...very minor over the years but nothing remotely approaching this.
I dropped out of the race, flew home, and went to immediate care the following morning. They immediately put me in our large medical center ER where my heart continued to put on a "good show" during the EKG. Conversion was occurring every few minutes continuous in the 39-130 range. I saw a cardiologist who set up an appointment for me the following Wednesday w/an electro physiologists. My heart was still converting as I fell asleep that Monday night and it hasn't occurred since...about two weeks ago.

My question:
During the race...an average of 140 miles/day through the mountains...I was able to recover to a large extent from day to day. I didn't feel like I was in the middle of a deep, deep level of fatigue.
Now I do. It's all I can do to get up and get anything constructive done for the day. Any walking brings on mild chest discomfort and frequent dizziness and a feeling of shortness of breath though no gasping. It hasn't gotten better, or worse, during the past ten days I've been home.
My question: Could such a long term run with continuous svt converting resulted in this long lasting fatigue? The EP cardiologist wasn't particularly concerned about the duration of the SVTs and recommended no treatment. Also, my resting pulse when I'm in otherwise excellent cardio shape is commonly in the mid to low 40's. I just checked it after sitting for 30 min or so and it was 64.
Should I be concerned and go in for a follow up appt. or wait it out and see what happens?


Thanks

[pvctom]

hello,

I am not a cycllist, but I have been plagued with chronic PVCs for over 30 years. And I can relate to your unrest. I have read the article on the link Artaud provided, and I too find it a wonderful clearly stated article on benign PVCs. I love bullet point #2 where he uses the adjective "capricious" to describe, why they come and go, then come and go.
my situation exactly.

best to you

[tom_h]

Wow, I'm sorry to hear that news from your acquaintance.  My amateur cycling career ended in 1980 while in a Memorial Day criterium (never did road courses because of SVT) in Allentown, PA.  A fellow a few positions in front of me caught the inside crank on a curb while going through a corner and went down.  I hit the pile too and went down hard on my right shoulder.  After they untangles the mess of riders, I was bleeding badly from road rash but stood up, and went to adjust my jersey.  I couldn't lift my right arm without searing pain. An EMT pronounced it just a bad bruise.  I got help packing up, and I managed to drive the 2 hours back home, single armed, but instead of spending the opening day at the swim club with my young family, I spent it in at the hospital emergency room.  An x-ray revealed a separated AC joint, and the end of my collar bone was broken and bent downward.  Two surgeries, screws, immobilizer, and almost the entire summer later I was on my way to recovery.  I assessed my family and career responsibilities, and listened to my pleading wife to give up cycling.  I had fallen many times on the track in sprints, but had never been badly injured before.  I decided then and there that was my last race, and I just stopped cold turkey.  I sold all my bikes, wheels, racks, assorted components, and maintenance equipment and never looked back mostly for fear of changing my mind.  It was probably the best decision of my life.  I bought a sailboat, and began sailing on the weekends with wife and kids rather than spending it driving or flying somewhere to a race... and for what?  Certainly nothing I could put in the bank or on the table.  So perhaps it was an injury rather then SVT that ultimately stopped me.... and my wife,  but I had already begun to assess my situation and the fall just pushed my over the edge.  I hope you come to a successful resolution with your situation.

[johnnyrocketman]

Your insights and experiences, Tom, with SVTs over the years from your athletic background  gave me some pause to reflect yesterday while I was doing some light gardening. The risk/benefit is definitely something I need to reconsider. I've done some competitve racing over the years and have done my share of throwing out the ribbons, etc in the trash years later. I'm thinking I've done my last long race. Your point w/EP not personally experiencing an episode of svts is well taken. It's one thing if it happens to someone else.It's an entirely different matter if it happens to you(me), etc. especially if the initial episode is grandioise.
The risk? Unrelated but while in W. Yellowstone for three days at the hostel, I got to know another senior citizen, Craig, who was touring, not racing, his way across the US. Fast forward to this Monday. He wrote to say he'd fallen somewhere...a poor road shoulder in Iowa...and fractured his femur.
Though not related to heart rhythms, risk assessment, racing or otherwise, is important as we age with greater vulnerabilities to the outside as well as inside world. Your points were well taken.

[tom_h]

It's easy for them to say that, perhaps never experiencing the effect as well as after-effects of an SVT episode.  I know only too well of competing with SVT,  I did it practically all of my life.  There were days.... even weeks I could go out and skate, cycle, or surf, and I'd be fine.  The next day though, perhaps in the middle of an event it would hit, and it would force immediate withdrawal.  When the final placements and perhaps selection to a national team for world competition are dependent on finishing all of the events, say from 500m through 10K and you miss even one event, you can forget about it.

By the way, knowing the little I do about SVT, even back in my teens when I felt invulnerable, SVT stopped me.  I didn't want to risk a possible crash from syncope, or possible heart damage.  At our age, that risk increases significantly. It was the driving factor behind my deciding to get it fixed.  When the cardiologist calls you  at 10:30 at night after seeing the SVT trace from the monitor, and discusses high rate SVT on an "aging heart", regardless of its condition, then pleads for you to get in as soon as possible to discuss the options, you have a tendency to sit up and listen.  Also too, as I matured, I realized that the rewards for all of this incredibly hard work was just a medal and a title.  I wasn't getting paid to do this.  Rather it was me who was paying for flights around the country, food, and lodging.  The reward was a medal, or a cup, and your picture in organization's monthly magazine.  I wasn't worth the risk.  Ultimately age and career responsibilities crept up and stopped the running around.  So I would absolutely continue to ride, but I would go forward knowing that if you have an episode, that's it for the remainder of the day.  You stop, you rest and recover.

[johnnyrocketman]

Thanks, Tom and Michelle, and others once again as I've certainly appreciated your help and guidance thru this arrhythmia thing.I'm optimistic I'll get to the bottom of it all.

As to how I'm feeling? Essentially the same but will try pushing a bit harder though I do get tired just walking around the house. Was thinking of a short bike ride today but...I don't know. Going from 10 days of extreme exercise to two weeks of virtually nothing physical has been quite an adjustment.

As a side note, I asked the EP at yesterday's appt. once again about ultra racing...thinking of next year already...and he said the 'SVTs shouldn't hold me back' and that  'you can race with SVTs'. After coming off six days of continuous converting several weeks ago, I find that idea a bit disconcerting as it wasn't an experience I care to repeat. He didn't seemed concerned that it should slow me down. I'm just not sure what to think at this point. Like I've said...wait and see. Thanks again...John

[tom_h]

Another test also often administered is a stress echo to look at the physical structure of your heart under (well, just after heavy physical output).  I think it's really good that you're going to get a 30 day monitor.  If you've never had one: They're so small that they don't get in the way, and you can wear it riding, running, or what ever.  The only time you need to take it off is showering or swimming.  It's just a 2 lead recording, but that's all you'll need to have evidence of whatever is going on.  They'll usually brief you on it operation when you pick it up, but it doesn't hurt then to ask how it's recording.  Typically, when an anomaly is detected, it jumps back in the loop, and begins recording to memory an amount of time before the event began.  This way, it catches the event initiation, which can be very important.  The reason I mention this, is there was a person a couple weeks back who claimed their recorder was not catching the event initiation.  It helps to ask questions.  This is one time that you hope for something to happen.  Good luck, and let us know how you make out.

[MichelleP_3811]

That is how it goes sometimes.  Hope they can figure out exactly what it is.  Are you starting to feel a bit better?  Good luck and keep us posted.

[johnnyrocketman]

Well,  my wife joined me for an appt. w/my EP this morning. Had the 12 wire EKG and nothing special or unusual turned up other than the usual pvc we all have from time to time. I strongly suspected I was experiencing AFlutter but apparently not. Back to square one. In order to rule out heart disease/atherosclerosis, etc, Dr. is lining up a 'nuclear treadmill' test as well as a 30 day event monitor. At this point, it's wait and see ;)

john

[johnnyrocketman]

Thanks again, Michelle,for taking the time to help guide me as to my course of action. You've given me new insights, methods, and ideas in dealing with this new area of my health that, three weeks ago, I never would of given it a second thought. Tomorrow I'll call my EP and try to get an appointment soon as the fatigue I've been experiencing these past few weeks, as well as the  chest discomfort/breathing has me feeling like an old, old man beyond my years.
Kindest regards,
John

[MichelleP_3811]

The good news is Afib is a bit hard to ablate which they ruled out but accessory pathway svts are fairly easy so long as you are active enough for the ep to induce an episode so he knows where to ablate which may be why he hesitated if he thought this was the only time it ever happened.  Unfortunately with any svt there is a risk it will come back without an ablation to correct the issue so I would consult with your EP about future races.  I would also contact him about the fatigue if it isn't improving by now.  The fact you are still having mini episodes may be compounding the problem.   But it could also help the situation by giving your EP more faith it can be ablated and you can go back to racing without fear of what happened reoccurring.  

The interesting thing is I think your well conditioned heart may have been masking a problem you have had for quite a while.  I know before I started to take up a cardio routine my svt would lay me flat.  I had to lay down for fear of passing out.  After I started to work out I could actually function through the svt.  Not as well as you appear to have over the years but there was a marked difference.  It could also be why your rate is lower than what would be expected for an svt like mine though there are multiple kinds and they don't all present at super high rates.  This said, I would discuss all of what you have said about your history with your EP and the fact you are still having episodes is actually a good sign he may be able to ablate after all and get you back to cycling without fear of an episode.  

The one last thing I will say is that unless something is caught while you are actually in tachycardia your heart will be labeled healthy.  Some have even been told it was just stress and anxiety.  So just be clear about this being a history with you on and off.  For me, I had a 24 hour holter and had an episode the day before but not the day of so I was written off as healthy. I needed a 30 day monitor to finally catch what was going on.  We must be persistent if there is a problem and impart on the doctor that further investigation is needed.  However, it is apparent there is an ongoing issue that has been captured now for you.  I would say go back to your EP before 6 months to discuss your history and options considering your want to cycle.  The other thing is to try vasovagal maneuvers like bearing down straining to go to the bathroom and holding your breath or drinking a very cold glass of water.  If you can get the episodes to stop on their own you may help alleviate any wear and tear on the heart.  Anyways, I think it important you talk to your EP most importantly about your fatigue, your continued episodes and what options you have for a cure.  Best of luck.  Keep us posted on how you are doing.

[achillea]

Excellent article, simple and clearly written!

Actually, it should be required reading for many worried medhelp members with benign PVCs.

[johnnyrocketman]

Whoops...June 23rd appt. w/EP should of been June 25th in the timeline.
john

[johnnyrocketman]

Thanks so much for your insights, Tom, as well as others jumping in. I'll try an answerthe  questions you had w/a brief timeline as well as other comments:
June 17th 9a.m.
First noticed SVT's 60-160(rounded) convert rate every two-four minutes. When they initially started I used iPhone 'stop watch' to check rate/frequency. 4 min. 160, five min 60. Then back to 160. This continued as above on ambulance ride to Rexburg, Idaho, that afternoon.
June 20th
Admitted to ER in hometown for three hours still converting every few minutes. Rate I saw on monitor varied between 39 and 130 during that time.
Converted until evening of June 23rd. When I woke on 24th the converting had stopped.
June 23rd..appt. w/EP. Dr ruled out  AFib but indicated I might of had AFlutter  going on a some point but wasn't sure. He had access to all my EKG tracings as hospital in Rexburg gave me a packet to give to EP back home. I actually brought them w/me to the ER the preceding Friday and they forwarded them on. Btw, I did see a cardiologist at the ER in my hometown.
History...I've had prior issues over the years w/fatigue, etc and with tachycardia...very transient in nature. I've had echocardiograms, warn a halter twice, twice on the treadmill, etc and everything comes up perfect.
Last time I went to cardiologist for what I call Phantom arrythemias ...a different doc than I'm seeing now...nothing came of it. Quite frankly, I thought they thought I was making up the whole thing, etc. I wasn't

More history...over the past few years...only while laying in bed quietly at night...I'd lay there before dozing off and check my resting pulse off the 'ceiling' clock. When my pulse was down in the 40's I thought I was in pretty  good aerobic shape. But here's the catch. I'd be counting my pulse beats and, at the same time, I'd feel this runaway pulsing in my chest at a phenomenal rate. It'd last maybe 5-10 seconds and then be done.
Well...it happened this morning before I got up and, unless it's my imagination, I can press my fingers against my chest and feel it constantly almost like a quivering. Anyway, to shorten the story, I was wondering if it be something like AFlutter going on or what? I just don't know.
Symptoms:
Extreme fatigue down to the bone type
A lot of dizziness when transitioning
Weakness
4/10 chest pain
Fyi...just two weeks ago I was doing 150 mile days w/7-10,000' of climbing and recovering well. Now, I find it takes a lot of effort just to walk around the house.
My EP cardiologist diagnosis/treatment:
Ablation success questionable if not currently experiencing SVT
Said SVTs were only dangerous if they went on continuously for two weeks
Recommended no treatment. Check back in six months.

I feel I'm really in limbo. I'll like to race the TransAm again next year but currently have no guarantee the SVT's wouldn't return.
Sorry to have been so long winded and thanks for your feedback...

Kind regards,
John

[Iva_87]

Oh my god, I had this once, I spend the morning in the hospital and then it stopped. How can you be so cool still and live your life on? I would be sleeping at the stairs in the hospital praying to help me somehow :)

Hope you get better soon and you find some answers.

[MichelleP_3811]

Were you told what type of svt you had, was it accessory pathway or afib.  There is a pretty big difference between the two.  Also, you say you had minor arrhythmia issues for years.  What does that mean?  What has been going on?  I had an svt avnrt which meant I had an extra muscle fiber leading into my heart that would cause my heart to race into the 200s.  I had it all my life but most of the time the episodes were very short until one time I could not get it to stop.  It went on for 8 hours.  Afterwards I felt an incredible fatigue like you mentioned.  Essentially the heart was really overworked.  I can't really remember how long it took for me to recover but I was also 30 years younger than you at the time.  Have you discussed this fatigue with your cardiologist?  Hearts are amazing muscles and can repair themselves pretty well but because they have to keep working the process can take quite a while.  I would suggest while you are having deep fatigue that you avoid exercise if you can.  Give you heart as much time to rest as you can.  If this persists though please do inform your doctor.  

[Artaud]

As an afterthought, your situation being beyond my experience, I do remember seeing this article about PVCs. The Electrophysiologist that runs this site is also a cyclist. See paragraph #5 pertaining to athletes experiencing PVCs, essentially, I'd guess, from being over conditioned.

http://www.drjohnm.org/2013/06/benign-pvcs-a-heart-rhythm-doctors-approach/

Best wishes.

[tom_h]

Question for you:  What course of treatment did the EP recommend?  Also: how long are these SVT events.  If they're of short duration, a half dozen to a dozen beats, are they sure it's not NSVT rather then SVT?

[tom_h]

The good thing is, they got it on paper, and you have evidence and a diagnosis.  160 isn't particularly fast for SVT where "normal" rates are 200 and up.  At 60 before mine was fixed, I'd experience rates around 240.  When my electrophysiologist saw this rate, he was concerned about the quick rate versus my age, more so as I got into my 60's and beyond.  I too have an athletic background participating in sprint cycling and speed skating, and had SVT throughout my lifetime from 6 years old until 60.  While it may not be a problem for you now, it could be as you get older. Right not though it's really interfering with your life, and I'd want to get someone to get in there take a look around, and ablate the problem so you could get on with your cycling.

Yes, SVT events can result in a period of fatigue afterwards.  I think everyone who experiences them feels a little drained after one.  I usually had an "off day" following one of my SVT events.  These were self sustaining, and would run on for hours and hours if not converted by me.  I used Valsalva to slow mine.  If you continue to experience these salvos of SVT, I'd ask about getting someone to fix them for you.  You will most likely find drug therapy useless.  Cardiac ablation is the way to go.  It gave me a normal life that I really never had experienced before when SVT was always lurking.

[Artaud]

My sympathies to you, you've been through a lot. My frequent PVCs pale in comparison. If you're new to the forum, I'd expect Tom_h to jump in on this one, sounds like things he can really relate to.

Best wishes for a restored normal rhythm.