Diagnosed with svt last week, need support

[Crazymoaningegg]

Hi

I got rushed into resus last week with a heart rate of 220-250bpm. Had an ECG and stayed tachycardic for 2 hours but luckily it went away just before they were going to give the medication. Since it's happened I've been given propanol. But I feel like the rugs been pulled out from under me. I'm only 26 and I thought I was going to die. It was so traumatic and I'm now stuck feeling exhausted, dizzy, scared, anxious, sleepy, nervous. Doctors can't tell me if it will happen again, I had a small episode about 5 years ago but ECG was normal after 15 minutes so thought nothing of it. Now this new incident has happened I'm petrified and feel like I'm not going to make it to 30. I'm just so lost. Anyone else been through this? Thanks

[Hidden]

With the caveat that I’m not medically qualified, and apologies in advance, as this is likely to be a fairly long reply. The first thing to say is that for all it’s a truly horrible experience, of all the arrhythmias to have, SVT is considered fairly benign. In medical terms it’s more of an inconvenience than a serious problem, and it’s not life threatening. If I had to choose an arrhythmia to have, then SVT would be it, and I actually had my first bout at the same age as you. Never had a palpitation in my life until then, only to suddenly have a hummingbird in my chest. Was stuck at 240bpm for about two hours total, but they gave me adenosine in hospital to stop it. I was then kept in for 5 days as my heart rate was all over the shop, and sent home on a beta blocker similar to propanol. That was in 2009. I’m now almost 39.

Some people have 1 or 2 episodes and never have it happen again. Others, like me, have lots of episodes. For about 6 years I was having 2 or 3 prolonged episodes a month on average, and lived in fear of them. However, I wasn’t receiving good care. I was never told that I should attend A&E for any episode lasting more than 30 minutes, and I wasn’t offered an ablation to try and permanently stop it when I should have been given how regular the episodes were at that time. This probably all sounds terrifying, but I’m telling you all this because my story has a happy ending, and it’s important to know that there are things you can do for yourself to try and prevent episodes from happening going forward. My last major episode requiring A&E was in 2015, and it was to be my last episode to date.

We know that SVT is triggered by premature contractions of the heart. They can be from the top chambers, in which case they’re premature atrial contractions (PACs), or from the bottom chambers, in which case they’re premature ventricular contractions. Colloquially they’re often referred to as ectopic beats or ectopics, which is a term you’ll see quite a lot on posts here, and are something that we now believe the vast majority of people experience. Only a minority are physically aware of having them, though, many of whom seem to be people with an underlying heart condition or arrhythmia, and they’re only considered a problem in their own right if you’re having several thousand a day (a ‘burden’ of 10% of your daily heartbeats or more), or runs of 3 PVCs or more without a normal beat in between. We also know that once you start noticing them, it can become a bit of a vicious circle, adding to stress and anxiety and causing more in turn.

The problem with ectopics is that because they are benign in the vast majority of cases, even for those of us with underlying arrhythmias triggered by them, and because we do know when to worry about them, not much research has gone into understanding why they happen. We know that they’re often adrenaline mediated, meaning increased and triggered by the release of adrenaline. Beta blockers help SVT patients (in theory) by blocking the release of adrenaline, thus reducing/preventing extopics and hopefully controlling the episodes of SVT as a result. However, if we’re doing things to increase adrenaline release at the same time, so drinking beverages containing caffeine for example, then for some people the meds will not always be effective enough in preventing episodes.

Whilst they don’t apply to everyone, medically we know that there are a number of things proven to be able to worsen or increase the frequency of ectopics. These include:

Caffeine, including in all teas and coffees, soft drinks and medication

Dark chocolate

Medications, including but not limited to asthma inhalers, antihistamines, and cold and cough remedies containing pseudoephedrine.

Alcohol

Nicotine, including nicotine replacement and vaping

Recreational substances, particularly stimulants

Stress

Anxiety

Insufficient sleep

Studies in recent years have found that tyramine in foods like bananas and fermented products can be a trigger. Spicy food is also anecdotally well known to be able to cause them, although it’s yet to make the official list. I’ve also seen quite a few women here suggest there can be a possible hormonal element in their experience.

In addition to the above, we know there are also patients that get ectopics as a result of stimulating the vagus nerve simply through the act of eating and digesting. For them, smaller, more frequent meals are often better than large meals. Some also get them from certain positions: I can reliably give myself ectopics by lying on my left side or bending forward and down. Ectopics that arise like this are coming out of the parasympathetic nervous system, sometimes referred to as the system governing ‘rest and digest’, where the ones coming out of substances and stress are arising out of the sympathetic nervous system, which is the root of our fight or flight response. We produce adrenaline in an effort to outrun danger or fight to save our lives.

Back to my own story. I was having dozens of episodes, and the big ones left me exhausted for weeks. No amount of submerging my face in cold water or bearing down brought episodes to an end, I just had to sit with them until they spontaneously stopped or I ended up going to hospital. After the last episode in 2015, where I’d also felt really, really unwell for the duration, I said enough was enough and began to read up on SVT and ectopics in detail. My consultant after the first ep had told me to avoid caffeine, but that was it: I’d ignored the advice, so took that as the first step, and promptly discovered I am someone that’s sensitive to caffeine when it comes to ectopics. I then worked my way through the list to see what else effected me, and discovered dark chocolate and insufficient sleep were also massive triggers. The worst episode I ever had not requiring hospital treatment was after taking covonia cough mixture containing pseudoephedrine. I also seem to have an issue with ginger, although it’s not something that appears in literature.

My last holter monitor before making these lifestyle changes showed I was having several hundred ectopics a day. A few months after the changes, I was down to about a dozen a day, and that remained the case when I had another holter in 2021. Less ectopics means less chance of SVT episodes, means less fear and anxiety, and in my own case back to living a normal life. People are sometimes quite defensive about it, but for anyone where SVT or ectopics generally are an issue, I always say that you have nothing to lose by looking at lifestyle factors and seeing if they make a difference. The worse that could happen is nothing changes: giving up caffeine was a challenge for me, but worth it for the end result, and I do quickly notice the difference if/when I burn the candle at both ends, or choose to order a chocolate pud in a restaurant (many desserts are made with dark chocolate).

I really hope some of the above is at least reassuring if not useful.

[Easternmost in reply to Hidden]

what a fantastic reply - everything that you say is helpful and what I have found to be true. I also had episodes of heartrate up to 250bpm. Eventually at 52 things stopped self rectifying and I was diagnosed with atrial flutter. This was treated with an ablation. I am so grateful for the treatments available and self-help. Anxiety can be the hardest element to control, but again , there are many useful techniques to manage this.

[devonian186 in reply to Easternmost]

That was a great reply and very comprehensive. Are there any lifestyle factors that could be affecting you. These could range from being overweight, drinking, a change in personal circumstances a change in diet?

[Puzzled8 in reply to Hidden]

As well as the usual meds, I was also advised to cut out caffeine while in hospital due to SVT. I’m rarely without a cup of tea in hand but switched to decaf immediately - not quite as good as the real thing, but doable ! I didn’t think it had made much difference as I still have high HR, but it’s probably not as high as it was. Thanks to your info, I will now look into other possible causes and see what other changes I can make - not sure I’m willing to give up chocolate though 😊

[Pinkgolf in reply to Hidden]

fantastic reply , thank you for sharing your info and experiences 😊

[mczz in reply to Hidden]

Omg you're reply was as if you have been following my experiences to overcome a similar problem. I too have cut out all caffeine , try to eat smaller meals and avoid food/alcohol triggers. One that is a definite trigger is Chinese food, not sure if its the msg they put in it to thicken sauces. I'm not a very good sleeper either and notice when in real need of catching up. I'm a great believer in food is medicine so try to eat things that are not going to trigger. I follow Dr Berg on YouTube he has an amazing knowledge on all sorts of ailments and many all boil down to diet and especially Carbohydrates and sugar. I feel great when I cut right down on these and notice straight away if I've had too much. Vitamin deficiencies can also be a problem too and although we have blood tests it's not always on all/every vitamin and mineral. Something else to try for anxiety is reflexology and visualisation/meditation (again on YouTube follow The Honest Guys) if anything you'll get a good sleep.

[Shad0wlands]

Thank you for sharing your experience, I had my first series of episodes last week and I am now awaiting further investigation, though not sure when that will be. I have learnt more about SVT from the great replies posted here, such a great help at at worrying time. Thanks to all

[Fazerboy]

Hi, wow a long text above. Not much to add except I had svt and found it was triggered by an adrenaline rush ie a sudden shock or surprise ie a near miss when cycling or similar. Second, I found that when in svt I could reset my hr by lying on my back and relaxing. Difficult at times depending on where you are. I eventually got put on bisoprolol but didn’t like it. I eventually had an ablation. All good ever since, no meds, no svt.

Good luck.

[Gremlin87]

I was born with Wolff Parkinson White Syndrome. Started getting SVTs at the age of 15 numerous times a day of up to 220bpm sometimes for up to an hour and a half at a time by which point I would begin to black out and the pains in my chest and up my neck were horrible during this. My Cardiologist told me I needed an ablation in March this year for left-sided AVRT. The first attempt didn't work, second attempt did. It was the most excruciating pain I have ever felt. I felt every push and shove into my heart where they had to puncture through to get to the left side. Had a bad bleed from my femoral artery afterwards but the staff were brilliant👍 you can't even see the scar now. Still have odd episodes of SVT, fluttering etc. but overall much better. On the whole i'm glad I had it done as it had been ruining my life for past 18 years

[Stumpy47]

I'm 75yrs & suffered with undiagnosed svt right from childhood the episodes had always self converted after approx 15/30 mins max. It was only in my late sixties that the episodes were lasting hours on end & needed Adenosine to convert me back to nsr. I had always had a naturally slower HR as well. But tests showed Bradycardia as low as 24bpm at night. I ended up having an ablation which cured the svt, but needed a Pacemaker for the Bradycardia. I would certainly recommend an ablation if you are given the option. If your cardiologist thought you were at risk I'm sure he would have discussed it with you, I can understand your anxiety though. Best wishes on your journey.