Questions about SVT and ectopic beats

[MikeT74]

Hi all, I know this is pretty insignificant after looking at a lot of the posts here but I have a few questions if I may..

I have previously been diagnosed with ectopic heart beats, where on the 24 hr ECG my pulse dropped as low as 33bpm.

Removing caffeine from my diet had significantly reduced the issue, however, last week my heart rate went to over 175 and stayed high until I sat down, then it dropped and had ectopic every 5 to 10 seconds until I stood up and it immediately raised to 175+ so after over half an hour of this I went to A&E and the ECG showed 175 again.

Although after about 45 mins it self corrected, they kept me in and diagnosed SVT. I was then transferred to another hospital to the respiratory unit for 2 days, had blood and urine tests along with several ECG's and eventually prescribed Bisoprolol Fumarate 1.25mg

My questions are, is this likely to be an issue with my already quite low resting hr (day time 55-60, night around 45-50)?

Can I still use my exercise bike, and go for 4-5 mile walks?

Can I still drink alcohol (I literally drink about 6-8 units on a Saturday evening only)

And finally, as they never explained at all, even after I asked.. what is meant by "Discharge is advised home with safety netting advice"?

Sorry it was long and thanks in advance.

[meadfoot]

Have you got any follow up with your hospital, another appointment for example or discharged to the care of your GP assuming you are in the uk. Did they give you any information about safety net advice for follow.

I have svt and it is awful so i understand your issues. I take atenolol, flecainide and of course an anticoagulant. Please ask for support from your medics. Does the hospital have an arrhythmia nurse it may be worth ringing them to see where your support will come from. On thing i would suggest is you rethink alcohol, it isnt a good idea with our condition. Good luck,

[MikeT74 in reply to meadfoot]

Thanks, I am awaiting an outpatient appointment in 6 weeks time with the cardiologist, and have spoken to my doctor this morning, who advised similar re alcohol, and just said if it happens again, go to the hospital.

[meadfoot in reply to MikeT74]

Glad you have contacted medic. Best wishes.

[Hidden]

So, SVT is considered a benign arrhythmia - pretty unpleasant, inconvenient, but not particularly dangerous. It’s triggered by ectopic beats, often from the atria (because SVT originates from ‘above the ventricles’), so the more ectopic beats you have, the more likely you are to have a bout. Treatment is therefore geared towards reducing the ectopics, and bisoprolol is usually the first line of attack. The dose you’re on is the smallest possible dose, with the max being 10mg, and some of the most common side effects tend to be a drop in blood pressure, and the impact on resting heart rate. As you have a lower resting heart rate to begin with, it may be worth just keeping an eye to see, but the low dose may well be in deference to that.

SVT is very individual, and not actually that well understood, with some people having really frequent bouts, but others finding it only happens once in a blue moon. I had my first bout of SVT aged 26 back in 2009. After that, I was routinely having regular episodes in spite of varying doses of bisoprolol, sometimes 2 or 3 a week, until I had another major one in 2015 once more requiring a drug called adenosine in A&E to reset my heart. After that, I did some reading, and grudgingly began completely cutting out all the things medically known to increase ectopics to establish which - if any - were contributing to the problem. In doing so, although I do still have ectopics and require medication to help keep them under control, they have decreased massively and I haven’t had a single episode of SVT since. Unfortunately, for some people exclusion and lifestyle changes make no difference, but the things medically recognised to increase ectopics are:

Caffeine (all caffeine, including in tea and some over the counter medications)

Ginger

Dark chocolate

White chocolate

Some medications, including but not limited to asthma inhalers, adrenaline based products (like normal lidocaine for local anaesthetic), and pseudoephedrine which is a decongestant found in many cough and cold remedies

Tobacco

Alcohol

Recreational drugs

Insufficient or disturbed sleep

Stress

In my case, caffeine, dark chocolate, ginger, and pseudoephedrine all turned out to be culprits, along with lidocaine, and not getting enough sleep. Other people also swear that spicy foods set them off and have had good success cutting these out, although this isn’t on the official list as yet. For me personally, alcohol didn’t increase my ectopics, but after the SVT began it did quite often give me bounding (forceful) palpitations generally even after just one drink, so any decision to have a drink was taken knowing there was a 50/50 chance of feeling pretty guff. Exercise is an interesting one: some people find it increases ectopics and therefore can trigger SVT, others find it reduces them, but there’s no apparent rhyme or reason as to who will experience what, and exercise is really important from a cardiac and health standpoint generally. I routinely do 5 miles in sub 15 minutes on my exercise bike, with my hr exceeding safe maximum by age (my heart rate is a bit all over the shop these days, rising 20bpm if I scratch my head, but this is unrelated to the SVT), and cardiology have no issues with this in my case. My advice would be to take it steady in the first instance and see how you get on; if it does trigger SVT then you need to seek advice and be guided by the medics, and may need to look at your medication, or consider modifying the intensity of what you do.

The safety netting advice bit...I’m assuming what they’re talking about here is advising when to seek help for an episode. I wasn’t given this information originally, so endured some pretty prolonged and unpleasant bouts at home for years before another doctor looked at me aghast and clued me in: some episodes are self-limiting and may pass quickly, but others aren’t, so the advice generally is any episode lasting more than 30 minutes, or any duration where there is chest pain and a sense of feeling generally very unwell, should result in a patient seeking help from A&E. My first major episode I had no symptoms other than my hr being stuck at 240bpm. My last major episode, I genuinely felt like I was dying - chest pain, breathlessness, dizziness, nausea, clammy and a bit grey looking 😬 There are a couple of things you can try at home first, though, including valsalva manoeuvres (like closing your mouth, holding your nose and trying to blow out, or bearing down hard whilst trying to blow through something like a syringe with the plunger still in it), or putting your face into a bowl of really cold water. Unfortunately, much like avoiding known triggers, these don’t work for everybody, but they’re always worth a go. The other thing often used in A&E as a first response is carotid massage, and some people are taught to do this if it’s found it works for them, but this is not something that should ever be done without first having proper training from a medical professional. As with valsalva manoeuvres, it also doesn’t work for everyone in any event.

Hope some of that helps!

Edited to add: if you do end up having frequent bouts, there are other treatments that can be tried. I just wasn’t ever offered anything other than medication despite other options being appropriate given the frequency.

[MikeT74 in reply to Hidden]

Hi Charlie, that was an excellent and well structured informative reply, so thank you kindly for taking the time for that. I only drink decaf and have for around 4 years due to the ectopic beats, but have thus far been OK with alcohol *although not whilst on the beta blockers, had 2 drinks Sunday night and felt wiped out)

Im used to my hr going low at night (in the 40s) so this extra drop from the BB won't be fun, but I now have had a little more info that matched yours. I just hope that they remain rare bouts, particularly now I'm on the blockers.

[Hidden in reply to MikeT74]

Glad it was of help, and fingers crossed for you. You may find yourself a little bit on pins for a while waiting to see if they’re going to be more than an occasional experience, but if they are infrequent (and there are some people who get it fully under control with beta blockers after just one episode), I’ve certainly found that uncertainty fades with time. Good luck 👍

[dawny1908 in reply to Hidden]

This sounds like me 😁 I usually end up having adenosine every time. I was told to give mine 15 mins and if don't stop then off to. A &. E