SVT single episodes

[cricricri11]

Is anyone having success at treating one-off SVT episodes with Bisoprolol or Metoprolol? And , if so, what dose do you take? TY

[Shrek2]

The last episode of SVT that i had was in 2014, and was not given any medication for it. I have diabetes and blood pressure , medication i have is Bisoprolol 10mg and that slows down your heart rate , also to bring down BP.

[cricricri11 in reply to Shrek2]

2014. Well, how lucky . 10mg seems like a lot to take for one episode. I suppose you have never tried taking it?

[Shrek2 in reply to cricricri11]

No i take it for blood pressure control along with candesartan, amlodipine, Bendroflumethiazide, aspirin, empagliflozin, aspirin, rosuvastatin, and just lately benzodiazepine for nerve control in arms, legs and feet, so who is lucky?

[cricricri11 in reply to Shrek2]

💛

[bantam12]

My Cardio suggested upping my Bisoprolol dose to 3.75 but it was to much so I opted to stick with 2.5 and put up with the svt 😕

[cricricri11 in reply to bantam12]

Do you take an extra pill when you have an episode?

[bantam12 in reply to cricricri11]

No i dont, although I have a lot of svt episodes according to monitors I'm either not aware or they are very short.

[cricricri11 in reply to bantam12]

well, I guess it then mean that the 2.5 a day is working

[bantam12 in reply to cricricri11]

Well no it isn't but I can't tolerate more and don't want to change to a different med so I just put up with it. I have other heart problems so it's a balancing act !

[Hidden]

Not sure what you mean by one-off episodes? A one-off to me means those lucky few that had SVT once, got put on meds, never had another one. My first ep, I ended up in A&E needing adenosine. Got put on sotalol initially (not in the U.K.), then switched to 2.5mg bisoprolol by the NHS when I got home. Over 9 years, went from 2.5mg all the way up to 10mg and back down to 1.25mg, yoyoing between doses, before switching onto verapamil in 2018, but between my first ep in 2009 and the very last, massive one I had in 2015, I might go weeks between episodes before having 3 in the space of 3 days. Over the course of an average year, I’d have at least a couple of dozen ‘minor’ episodes. No pill in pocket strategy, but as I now know, I wasn’t actually given appropriate advice or medical care at the time.

For me, meds are required to manage my heart rate and reduce ectopics: ectopics are the trigger for SVT, so the more you have, the higher the chance of a bout. But the most important factor for me was lifestyle changes. After ending up in A&E needing adenosine again, and feeling horrendously ill with the episode to boot, I decided enough was enough and completely cut out all the things medically known to increase ectopics. From there, I determined which ones I’m sensitive to, and by staying off them, haven’t had a single episode of SVT in the last 6 years. I still have ectopics, but the burden has dropped from several hundred a day to 12 a day according to my last holter. Not everyone with ectopics has sensitivity to food stuff or other lifestyle factors, but for some people it can make an incredible difference.

[cricricri11 in reply to Hidden]

Thank you for your explanations. Funnily enough, no one ever even explained to me that ECTOPICS can make a difference. I was instead told by two cardiologists that there is simply no way to avoid having an episode; they also explained that since I "only" have five or six a year (which every time lasts almost a day thou) , it is better to just take a pill when needed (I think you call it "pill in pocket". The problem is that I can put up with going in "pause" mode every now and then if I have nothing planned . But I really need an escape route shall I not be able to pause on that one very day (i live alone , i work alone, i live far from friends sadly). Hence why I was wondering if the pill in pocket method could work . I will now go and research the ectopics topic 😜

[Hidden in reply to cricricri11]

I’m laughing and rolling my eyes at the same time that no one told you about ectopics - no one ever told me, either. In fact, the only advice I was given after my first episode was to stop drinking caffeine. As it turns out, I am very sensitive to caffeine in terms of it being an ectopic trigger, but there’s a whole bunch of stuff medically proven to increase the frequency of ectopics for some people that no doctor I’ve met has ever mentioned. Quite often when I reply to people asking about ectopics or SVT here, the response that comes back is that they don’t drink much coffee, or alcohol or whatever: it’s generally quite dismissive, even though it’s medical fact. I’m not a quack, and I have no interest in natural remedies. It does however make sense to me, when we know that these things can trigger ectopics for a proportion of people, to at least have a bash at cutting them out - it’ll either work or it won’t, and if ectopics are causing bother, you have nothing to lose 🤷‍♂️ In addition to certain food stuffs and some medications, insufficient sleep and stress are also proven to increase frequency.

Not everyone sees benefit from avoiding certain lifestyle factors, and that may be tied to the fact that we still don’t actually understand why ectopics happen. I’ve been very lucky, I think, in not having any episodes in the last few years, but if your ectopics are linked to lifestyle factors and you avoid the things that make it more likely, that’s obviously going to have some bearing. For example, that very last episode was triggered by frequent ectopics brought on by adrenaline based local anaesthetic to have a filling: the cardiologist that saw me in A&E told me that was definitely what had triggered the SVT. So now, if I need local anaesthetic for any reason, I have an adrenaline free version. The interesting thing about this was the dentist doing the filling had no clue about the risk between lidocaine and SVT, but the next dentist I saw was well aware of the possibility without me having to tell him. A lack of knowledge and understanding does seem to be part of the problem, and doctors are only human at the end of the day.

I was (incorrectly) told I only needed to seek medical help if the episode lasted for more than half an hour with a heart rate of 160 or more. The NHS actually stipulates you should seek help if any episode lasts more than 30 minutes, regardless of heart rate, or seek help regardless of duration if you experience any chest pain or symptoms in addition to palpitations, but for years I put up with bouts stuck at 140 and 150 lasting for hours on end. I don’t respond to valsalva manoeuvres to end SVT, but if you haven’t ever tried it, when you next get a bout, hold your nose closed, close your mouth, and then try and blow out long and hard. Some people use the same thing to make their ears pop on an aeroplane if that helps explain it better. The other thing that can work for some people is plunging your face into a basin of very cold water. These are both methods advised by medical professionals, and the blowing one is one that paramedics often get patients to try. Carotid massage also works for some, and is usually the first thing tried for SVT if you wind up in A&E, but it’s not something you should ever try and do to yourself without first being properly trained.

[cricricri11 in reply to Hidden]

Thanks so much for your answer.

Sadly, I do not respond to any Valsalva maneuver either. I have not tried carotid massage because no one ever explained it to me properly. My episodes are rare but last for so so so many hours (the last one did last for over 22 hours). I have OCDs and really hate to go the hospital so I just sit on my sofa waiting for it to pass (I went twice when it first happened but then, when I explained I was exchanging a SVT attack for anxieties just for being in hospital, I was told to just sit down and wait it out and just make sure not to get up in order not to risk fainting). Which is why I am hoping that Bisoprolol will work as a “pill in the pocket” method. Also, needless to say that it usually takes me a few days go get back on track after an episode since I am soooooo exhausted.

I will pay attention to those ECTOPICS. I really cannot see any link for now, even if I think really hard about what/which they could be for me.

I moved to Germany a few years ago and I have been very unlucky with doctors since I arrived here, to the point of not going to see one unless 100% necessary (crazy, I know!).

Again, thank you so much for your kind useful message 😊

[HeartDinger in reply to Hidden]

I'm sorry to jump on your post I'm curious about these ectopics but is it possible for a medication to be an ectopic? I've recently started having episodes that sent me to a&e and I'm awaiting investigation. Paramedic suspected SVT but nurse disagreed on the night it happened. I've noticed my episodes only happen in the night roughly 2 hours after taking my medication. (medication I needed an ECG to be allowed on 7 years ago) it's caused these episodes in the past but they usually faded in a few mins after eating something. And I could prevent them by eating something before the medication. But occasionally I'm too tired and try without and they would happen. My episodes only happen at night within a few hours of taking the meds. I'm currently begging my GP to send me for a medication review with a psych as they are psych meds. In the day without betablockers my heart rate is between 65-80. It's such a long wait for cardeo appointments (almost 5 months so far 2 a&e trips so far I've only had an echo with no results yet) I'm trying to get myself clued up before I see a specialist again!

[Hidden in reply to HeartDinger]

Whether or not you could cause ectopics with medication in someone not already having them, I don’t know, but ectopics are common, not always noticeable, and there are several medications well known to be able to increase the frequency of them in those prone. The main culprits are antihistamines, some asthma medications, pseudoephedrine and other decongestants (often found in cough and cold remedies), and drugs that have an effect on adrenaline levels and stress hormones. Things like local anaesthetic are also included in that. But I actually know a bit about meds used in mental health, so I can tell you that SSRIs, SNRIs, and the newer, atypical antipsychotics like risperidone are all associated with ectopics. Some of the meds used to manage bipolar also have recorded case history for causing ectopics stemming from the ventricles, particularly lithium. I’m not medically qualified, but some of those meds are also associated with sinus tachycardia, so I don’t know if it would be unreasonable to suggest that they could produce something looking a little bit like SVT? SVT on ecg is essentially sinus tachycardia, but you’re ‘stuck’ at the elevated rate, which was initially triggered by an ectopic. They can also be self-limiting. At the time of my first episode of SVT, prior to which I’d never ever had a palpitation or any awareness of having ectopics, I was taking a couple of different psych meds and had been for quite some time: I do wonder now if there’s a link.

[HeartDinger in reply to Hidden]

I'm actually on inhalers and antipsychotics so that could explain a lot! the day before my first episode i'd taken a slightly higher dose of the antipsychotic which I now feel could have been the catalyst. But it's all just guessing games at the moment as I'm just waiting for tests. Honestly it's only crossed my minds since the episodes have always been in that 2 hour window, and I've only started to worry about them since they've got stuck in those peaks. I've wanted to get off the medications for a long time as I'm in a much happier point in life but didn't want to risk a break down. I'm doing it slowly whilst asking for help and advice, I'm going to keep pressuring for a medication review whilst awaiting my tests. All I've been told is to avoid caffeine and alcohol. I did both and still ended up having an episode seemingly caused by too much chocolate after taking my medication. Which I've now read that chocolate in the body can mimic caffeine so I wont do that again. Thank you for this post, I'm just trying to get myself as clued up before I see someone so I don't get ignored or kind of pushed off as "just anxiety palpitations" I want to recover whatever I have to do!

[Hidden in reply to HeartDinger]

Part of the major problem with ectopics is that we still don’t actually, medically understand why they happen. We know how to tell when they’re a problem, we know where they come from within the heart, but we don’t know why or what the underlying causes are. The end result of that is that there’s no guaranteed cure or even a treatment that we know will definitely work for the majority, and because they’re generally ‘harmless’, there’s no real urgency to try and understand or treat them better. Not everyone will be sensitive to substances and lifestyle factors, meaning they could cut everything out and still get frequent ectopics, but we do know some things can increase the frequency in people that are sensitive in that way. The things currently medically recognised to be able to cause/increase ectopics include:

Caffeine (all caffeine, not just coffee)

Dark chocolate

White chocolate

Meds as discussed above

Recreational drugs, particularly (but not exclusively) stimulants

Alcohol

Tobacco/nicotine

Stress

Anxiety

Insufficient sleep

That’s in addition to frequent, anecdotal evidence about chocolate generally, spicy food, and ginger. Ginger sets me off something chronic for a fact. There’s also increasing studies that show tyramine in food (often found in fermented products and things like soy) can and does cause ectopics and palpitations in those prone, although that’s not a route I’ve gone down beyond reading the papers and articles on it. I think the Times published one last year or the year before talking about the causal link.

I was having hundreds of ectopics a day and 2 or 3 prolonged bouts of SVT a month on average, sometimes a week, for about 5 years even with medication to lower my heart rate and reduce them. The first one happened when I was 26. After another major bout stuck in the 200s where I needed adenosine, and felt really ill with the episode to boot, I said enough is enough, did the reading, and made the lifestyle changes. I’d only been told about caffeine and alcohol by the cardiologist, but for me, cutting out all caffeine, dark chocolate, ginger, cough mixtures and certain cold remedies (along with adrenaline based local anaesthetic), and making sure I got sufficient sleep each night, lead to not having had a single episode of SVT in the last 6 years. I came off all my psych meds about 5 years ago. I still require cardiac medication, I still have issues with my heart rate, and I do still have noticeable ectopics from both my atria and my ventricles, but what we do know from a holter last autumn is that my hundreds a day are down to about a dozen or so total. The more ectopics you have, the more likely you are to end up in SVT if you have that diagnosis, so the aim of treatment is to reduce the number. That’s what bisoprolol and beta blockers generally all do: they lower the frequency, and keep the heart rate lower overall.

Because of my own experience, I’m a big advocate of at least trying lifestyle changes: if you have frequent ectopics and/or SVT (or atrial fibrillation, which is another arrhythmia that ectopics play a part in triggering episodes of), then you have very little to lose by making changes, and potentially a lot to gain. Unfortunately, we know it doesn’t work for everyone, but if it doesn’t help, people can just go back to what they were doing - it’s not going to harm by trying. You may find that coming off your meds in time may also help or solve the problem, but as you clearly know, that’s a gradual process, so considering other things you can try to improve things in the interim would seem to be a positive step.

[cricricri11 in reply to Hidden]

I could not agree with you more but I really have the feeling my episodes are triggered by positions , more than lifestyle factors. The only thing you mention I should try avoiding is caffeine, but atm , i have two coffees a day top. When I lay in bed on my left side for example, I often have to quickly return on my back because I feel my heart start "missing a beat" so to speak. Same , when I stay for too long bent down to pick up or fix something. I do not exercise any longer because I am way too scared. Oh well, I think it will have to be only one coffee a day then.

[Hidden in reply to cricricri11]

It’s a sad truth, but I honestly can’t even do one coffee. If I do, I very quickly notice increased ectopics, and I wouldn’t otherwise describe myself as sensitive to caffeine - I used to drink a substantial amount daily without issue prior to developing SVT. I reduced my intake to a couple a day after the first episode, but I now know it was a significant factor in my ectopics by how I respond if I have even a little bit. Six years on, I do really miss that cup of coffee in the morning, but I’ve found it’s just not worth it in my case.

Positional triggers are often overlooked, but Sanjay Gupta (the cardiologist) has a video on his YouTube channel discussing why position can effect some. It’s not guaranteed, but lying on my left in bed will quite often give rise to both noticeable ectopics and palpitations generally. He says that this indicates they’re vagal in nature. I occasionally get PVCs bending down, and that’s apparently to do with the pressure within the chest cavity increasing due to bending. You may have already seen it, and it’s a reasonably long watch at 14 minutes, but here’s the link to the video:

m.youtube.com/watch?v=tPdZj...(Not working as expected?)

[cricricri11 in reply to Hidden]

No, have not watched it , will do very soon. Thank you very much. I am honestly convinced by now (four years in) that mines are positional. Luckily enough , it means I might be able to have that coffee in the morning . I hope you found an honourable substitute 😁🙃

[Larachez2102 in reply to Hidden]

Hi Charlie I suffer with svt with heart rate reaching 274 -250 each time and having to go into hospital to get it sorted. Can have one a month at least, can I ask what things you cut out to stop your episodes xx

[Hidden in reply to Larachez2102]

See my reply above to heartdinger: it lists all the things medically known to increase the frequency of ectopics. Cutting things out doesn’t work for everyone, but it was life changing for me, and I always think it has to be worth a shot. You’ve certainly nothing to lose!

[Larachez2102 in reply to Hidden]

Fab thank you so much. I’m living on my nerves it’s making me not want to go anywhere or live at the moment. Xx

[freddiefox]

I have used 1.25mg Bisoprolol as a pill in the pocket on and off for years for racing heart due to anxiety. Seems to work fine but just recently I had a Holter fitted for 7 days to check on heart. Result from that is to ask me to take the Bisoprolol everyday and they have referred me to an Electrophysiologist next week for a chat. My heart rate seems fine now and I don't think I need to take the Bisoprolol every day but am willing to try it for now and see what the Electrophysiologist says. I am exercising more and have lost some weight so I think that might be helping. Unfortunately, I have Ankylosing Spondylitis and Crohn's Disease, which does put me at a bit of a risk from heart valve problems, so I think it's why they're checking me. Apparently my Holter monitor only showed up one episode of SVT (150 bpm) lasing 39 seconds, which doesn't sound bad to me🤔. However, will ask some questions at my appointment next week - will also ask about using as a pill in the pocket. Having said all that (sorry), it does help to regulate my blood pressure.

[freddiefox]

In addition to my last post - my heart rate drops to about 50 when taking 1.25mg every day, which is a low dose, so the GP tells me ('a tiny dose' is in fact what she said). I certainly wouldn't be happy taking any my more than that in my circumstances. They suggested 5mg - no way!! I think my heart rate would be on the floor. Again, questions to ask at my appointment next week. It's all very vexing, knowing what to do for the best.

[cricricri11 in reply to freddiefox]

Hey FreddiFox , I would really love to know what they will answer to the "pill in the pocket" method. I have the feeling I have sooo many episodes throughout the day unfortunately but never measured my heart rate over a few days. 50 is def low so I never would take more than 1.5 if I was you 😲. I still would love to go for the one off pill if possible (me). I also have anxiety but it is random, so I rather just take some Xanax here and there , LOL. Drop us a message if you'll remember next week. Thank you 😀

[freddiefox]

I will let you know what they say. I had a letter yesterday for a telephone appointment with the Cardiologist in a couple of weeks, so between them and the Electrophysiology department I should get a clearer picture. Am off for a Colonoscopy now - happy days!! Heart rate fine and anxiety 🙂 👌.

[cricricri11 in reply to freddiefox]

LOL, don't we have a lot of fun these days!?!? 😅

[HeartDinger]

I have bisoprolol in pocket and tried it during an episode but sadly it didn't work as well as it did the first time. I was taking it regularly, stopped for just over a week and had another episode randomly (I think triggered by too much chocolate as a treat?!) and it sadly only got my heart rate down to 120 even 6 hours later (I went to A&E but was too scared to try an extra dose as I'm asthmatic)

[cricricri11 in reply to HeartDinger]

At least you have a clue what your triggers might be. My episodes happen completely out of the blue. Madness.... 😒

[HeartDinger in reply to cricricri11]

I'm still learning whilst waiting for an actual diagnosis, I live very samey each day. Same foods, same routine ect so I know when I've done something different so it's just a guess but it fits with the timing.

[cricricri11 in reply to HeartDinger]

I had my diagnosis but I haven't got a clue what I could do to avoid them (well, the doctors told me I cannot anyway.. yeahhh). I have anxiety but it never happened during an anxiety crisis. It happened a few times while asleep and a few times when I bend down to pick up something. No links to food or drinks or medication. Pretty annoying :/

[cricricri11]

PS: how many mgs did you take to try to stop the episode?