Confused !!

[Sholita]

Hi I am new to this community. Feeling very anxious. Recently suffered SVT up a mountain. Couldn’t get mountain rescue do had to walk down very slowly with heart rate over 200 !! for 90 minutes. Was monitored in hospital for 48 hours. Structure of heart normal, normal X-ray just high bp and heart rate. Started on 1.25 mg bisopralol daily by hospital. My GP has told me to increase to 1.25 mg twice daily. Really worried as I don’t sleep well anyway due to protracted menopausal symptoms. Just need a bit of advice really.

[MichaelJH Heart Star]

Hello and welcome to the forum! I think a good starting point for you would be to read this BHF article and follow the relevant inks. The medication you are on seems entirely appropriate. I have been on Bisoprolol for over two years following a quadruple bypass without issue. A friend has virtually eliminated ectopic beats by eliminating alcohol, caffeine, chocolate and spicy food from his diet. I believe this may be helpful to you.

I would usually make comments on healthy lifestyle but as you go mountain walking you will not be a smoking McD's fan. It's worth checking out the Mediterranean diet recommended by the BHF. Good luck.

[MichaelJH Heart Star in reply to MichaelJH]

Opps, here's the link:

bhf.org.uk/informationsuppo...

[Sholita in reply to MichaelJH]

Thank you that is very helpful.

[Kristin1812 Heart Star]

That walk down the mountain sounds pretty traumatic. Just a word about bisoprolol. It can take a bit of getting used to, and some people say they never do. But I find I have to persist over the first week or so, and it’s now helping me.

This seems to happen when they have increased as well as decreased the dose.

I hope things settle down.

[Hidden]

In the grand scheme of things, although unpleasant, SVT is actually pretty benign as arrhythmias go. I had my first ep out of nowhere aged 25. Stuck at 240 for over an hour, nearly two by the time I was in hospital, but other than awareness of the fast rate and a low bp I felt ok. Had adenosine in hospital to get it under control, then spent 5 days in, but mostly because if I began to even talk it briefly shot back up to 200 despite being on beta blockers. Echo was normal, so it was ultimately classed as idiopathic SVT, but I’ve been left with a heart rate that’s quite reactive so it does still shoot up suddenly doing basic things, but usually only as high as 130 or so these days. For the next 5 years after diagnosis, I had regular episodes. Many of them were getting stuck between 140 to 170, some lasting 15 minutes, some lasting more than a couple of hours (I had incorrectly been told I should only present at A&E for episodes above 180 lasting more than half an hour), and there’s no denying it wasn’t fun. I then had another major episode in 2015 whilst in hospital with my daughter, stuck above 200, and despite being informed by the ward doctor, they left me sat in the empty A&E waiting area for over 40 minutes. By the time they finally triaged me, I was grey, sweating, and had chest pain, and they rushed me through to resus, slapping defib pads on as we went. Thankfully, adenosine sorted me out again, they kept me in A&E overnight, and I was back on the paeds ward by breakfast.

That was when I decided to follow the dietary advice in addition to medication: there are a number of things known to potentially exacerbate or increase ectopic beats, and ectopics are the trigger for episodes of SVT. I gradually eliminated things until I learnt which ones made me more prone to episodes, and can tell you that 5 years later, whilst I still have noticeable ectopics and palpitations every day, I haven’t had any further episodes of SVT. Unfortunately, not everyone finds any benefit from cutting out, but the things medically known to trigger ectopics are:

Caffeine

Ginger

Dark chocolate

White chocolate

Some medications including salbutamol, antihistamines, adrenaline based local anaesthetics (normal lidocaine), and pseudoephedrine, which is found in many cold, flu and cough remedies

Tobacco

Alcohol

Recreational drugs

Stress

Insufficient sleep

Some people also include spicy food, as per MichaelJH’s reply, but it’s not on the ‘official’ list yet. My worst episode of SVT not requiring hospital was triggered by covonia cough mixture, and it turns out I’m pretty sensitive to caffeine, ginger and dark chocolate. If I have even a quarter of a teaspoon of instant coffee, it will give me additional palpitations and ectopics, but for the first 5 years I’d been drinking normal tea and coffee all day every day, along with diet coke - bit idiotic with hindsight.

Feeling anxious is pretty normal when you have your first episode, and you’re also potentially going to feel quite tired for a few weeks, which is also normal after any cardiac event, but my advice would be to try and determine early on if any of the above have any impact, fully and permanently cut out any that do, and see what happens. Some people are lucky enough to have one episode and get great control with low doses of beta blockers like bisoprolol (I was on varying doses of that for 8 years), others find that even with dietary changes and medication they do still get bouts, but there are other treatment possibilities other than beta blockers, including a procedure called ablation if you’re suffering from really frequent, intense episodes. I think the main thing to try and remember is that although it’s not nice, of all the arrhythmias you can get, SVT is the one of least concern. Hope some of that helps.

[Sholita in reply to Hidden]

Thanks so much Charlie that is a very comprehensive reply and lots of things to think about. Funny enough I just made a smoothie with lots of ginger this morning and guess what it set off my ectopics. Will read your reply again and thank you for helping to allay some of my fears.

[dawny1908]

Hi I had been suffering palpatations for a few years and had 24 hr ecg and was told the palpatations were normal. So everytime after that I would just think they were normal and wait for them to stop. Hours sometimes. Then Aug 2019 I felt achey so went to docs and he sent me to hospital as couldn't get my BP as all he could hear was my heartrate racing. I arrived at hospital and was taken into resus.. I thought omg why am I going to resus... They wired me up to ecg tried all the manoeuvres to try to stop my heart racing. Nothing worked. Then was told they could give me a drug but would make me feel funny... I suffer anxiety so was a bit worried... They told me it only stay in your system for 10 seconds. I thought ok I can do 10 seconds... Then the feeling hit! How weird is it the dreaded adenosine lol. I was told it was svt my heartrate hit 196bpm. Some ppl get it and nvr get it again but others do. I was told if it happens again give them 15 minutes and if don't go then go to a & e. Since then I have been approx 10 times. Adenosine given every time. I gad 24 hr ecg 24hr BP and echocardiogram. Little minor things showed it mitral valve didn't close properly but apparently common in mid aged ppl.. I am 50 yrs old. The docs think mibe is stress related. Also when I was off work I nvr had any palpatations. Back to wrk and they started again. I once had some bonjela and palpatations started less than 3 minutes after. I'm on bisoprolol. Was started on 1.25mg and it does make u very tired but it wears off once u get used to it. I have recently been told to taje 1.25mg in morning and 1.25mg at night. But I currently gave 1 rabket at night and half in a morning. When I upped the half I was tired again. Am looking to up the other half when I'm off wrk for a week. My bpm do not seem to get as high now the go to appproc 150bpm. I don't drink alcohol tea or coffee etc have cut down on chocolate. Just hoping it soon starts to disappear... I do think it's linked to menopause too.. Sorry for the essay

[Breesha]

Bisopropol is a life saver for many of us , I have been on 10 gms for over 10; yrs , I

Have had no adverse affects , I am also on warfarin, Apixaban triggered gout .

I am not sure why you wanted to reduce your medication, but you should work with your doctor ,if you wish to come off the meds.

I