Concerned I have another heart condition

[Sassylassy]

For the last 2 weeks I've been having more heart related issues. I have SVT and am used to having a high heart rate but I've been having a normal heart rate with skipped beats and on some days I even experienced bradycardia. I've booked a GP appointment and they will do tests to find the underlying cause but this will all take time and in the meantime my partner is concerned and I'm trying to ease his mind while I'm freaking out myself. I've already had 2 ablations and am terrified if I ever need a third since I've been told I'm more than likely to end up with a pacemaker and the thought of that freightens me. Should I be concerned about my new symptons? Does anyone have any tips on what to do when I feel my heart skipping beats? When it happens I feel pressure on my chest and I find it difficult to breathe everytime it happens so any tips would be welcome !

[Hidden]

With the caveat that I’m not medically qualified. Skipped beats are premature contractions, colloquially known as ectopics, and the trigger for episodes of SVT. If you have SVT you’ll have had these skipped beats since before your first episode. They’re actually extremely common even in people without an arrhythmia, it’s just a lot of people don’t notice having them, even if they’re having them every other beat. If/when we do start noticing them, our bodies become attuned to them and often start noticing even more. The only time they’re really considered of concern is if you’re having runs of PVCs (ectopics arising from the ventricles) without normal beats in between, or if your overall burden of ectopics is more than 10% of all your heartbeats in a day. They show on holter, so that would be the easiest way to see whether either of those are an issue.

There are a number of things medically known to be able to increase the frequency of ectopics for some people. When I had my first episode of SVT, I was having hundreds a day, I’m now down to about a dozen as a result of dietary and lifestyle changes in combination with meds. I notice them all, but I’ve been living with it for so long now that, because my SVT is under control, they don’t bother me any more. Ironically enough, one of the things that can increase them is stress and anxiety, so it can be a bit of a vicious circle when it’s not a particularly pleasant experience. The things that some people find increase ectopics are:

Caffeine (including in tea and chocolate, and it doesn’t have to be large amounts)

Dark chocolate

Some medications, including but not limited to some inhalers, antihistamines, decongestants like pseudoephedrine.

Alcohol

Nicotine, including in nicotine replacement therapy

Recreational substances, particularly stimulants

Insufficient sleep

Stress and anxiety

Anecdotally, people also report spicy food can be a trigger (and eating generally, as the vagus nerve from the stomach runs past the heart, and stimulating the vagus nerves can cause them). Some people also experience positional ectopics, where bending or lying a certain way will trigger them - I can reliably give myself them bending forward and down, or lying on my left side. Not everyone sees any benefit from trying to alter or eradicate these factors, but for me, making changes was life changing, I was having 2 or 3 episodes of SVT a month, sometimes a week, but I haven’t had a single one in the last 7 years because I’ve reduced the ectopics.

Either way, I absolute agree that you need checking over and some tests run, but assuming that’s what they are, ectopics are usually benign for the vast majority of people: unpleasant, but that’s it, even in those of us with SVT and AF where they’re the trigger for episodes. It might not be relevant to you, but it might be worth mentioning that after 8 years on bisoprolol, I developed worsening, eventually symptomatic bradycardia. They switched me to a calcium channel blocker, and I’ve been fine since.

[Sauveur65 in reply to Hidden]

Thanks Hidden - I suffer with SVT - some interesting info to note

[Sassylassy in reply to Hidden]

Thanks for your reply, there's a lot of useful information here. I started out on a calcium channel blocker which didn't work for me but maybe they can try switching me from the bisoprolol to see if it makes any changes. I'll see if there is a certain trigger for the ectopics, didn't know they could cause an SVT episode.

[Hidden in reply to Sassylassy]

It’s medically proven that the vast majority of uncomplicated episodes of SVT are triggered by an ectopic(s), which is why, if you look at the things commonly associated with causing episodes, they’re all things that are known to cause or increase PACs and PVCs. It also explains why episodes can occur without any apparent trigger; the trigger is the premature contractions, and from studies, we now believe that most people have them, it’s just they’re not aware of them. What we can’t explain is why for some people it triggers SVT and AF and others it doesn’t, but that’s probably more to do with our general lack of understanding of ectopics and the arrhythmias themselves.

I still have daily ectopics, just far less of them, which in turn controls my SVT more effectively. Even though I was having frequent, prolonged episodes of 3 or 4 hours at 180bpm plus, I was never offered an ablation, just as I wasn’t initially told I should seek help after half an hour or if I felt unwell. I read up on SVT and ectopics out of desperation and discovered the above list of medically known triggers. The only thing I’d been told to avoid in hospital was caffeine. Like I said, they don’t work for everyone because some people are naturally prone to high levels of ectopics, but I always argue that it’s got to be worth a go if ectopics and related arrhythmias are causing problems. You’ve got nothing to lose.