Paroxysmal supraventricular tachycardia (PSVT)

A dear friend of mine has been having heart problems lately.  They started off about 9 years or so ago, and seemed to go away for a while.  Sadly, her symptoms have come back with a vengeance.  She had to wear a heart monitor for about two weeks, and then had surgery last week.  On top of it all, she has RA, Fibromyalgia, Periodic Fever Syndrome, Neutropenia, Raynauds, and Livedo Reticularis.  She's one of my very best friends, so I figured I'd write an informational blog about her heart condition. 


Normally, the chambers in the heart work together coordinately, contracting and expanding to push blood throughout the body.  They all work together like a team, knowing when to contract and when to expand at the right beat.  The heart knows this by an electrical signal that begins in the sinoatrial node in the heart.  Then the signal travels to the upper part of the heart, telling the atria to contract. (see diagram below)  Paroxysmal supraventricular tachycardia (PSVT)  can appear in any of those areas of the heart, when the signal isn't being properly sent.

This condition is seen mostly in younger people and infants.  Symptoms include: anxiety, chest tightness, palpitations, rapid heart beat, shortness of breath, fatigue & dizziness.  Symptoms can start and stop suddenly.  They can last anywhere from a few minutes, to a few hours. 

To diagnose this, a few tests are administered, including a normal physical.  The heart rate can run anywhere from 150 to 250 beats per minute (bpm), a normal bpm is 60 - 100, which can occur in between PSVT episodes.  These heart rates can occur sporadically, so the best way to diagnose is for the patient to wear a heart monitor from anywhere from 24 hours, to a week.  This helps the doctor monitor the hear rates, and to see if different everyday tasks seem to trigger the episodes, or if the rise and fall of the heart rate is random.

There aren't many treatments for this disease, sometimes treatment isn't necessary and symptoms go away on their own.  The type of treatment varies by condition.  Some people experience rapid heartbeat, slow heartbeat and a combination of both.  Depending on what the patient is experimenting, is what will determine treatment.

Emergency treatment include surgery called Electrical cardioversion, which is when use of an electric shock on the heart, sends the heart back to normal.  Medication can be given through a vein, such as adenosine, and verapamil.  Other medications that could possibly work are procainamide, beta-blockers, and propafenone. 

Long-term treatment includes: Daily medications of propafenone, flecainide, moricizine, sotalol, and amiodarone.  Pacemakers, which are used to override the fast heartbeat (this is more commonly used in children with PSVT who have not responded to any other treatment.)  And, Radiofrequency catheter ablation, which is the procedure my friend had and the number one treatment currently for PSVT. 

Here is an explanation of Radiofrequency catheter ablation taken from an article on uptodate.com written by Leonard I Ganz, MD. 
"Small catheters (special wires) will be threaded into the heart. The catheters are usually inserted into the vein or artery in the right and left groin (inner thigh) and are then positioned within the chambers of the heart using fluoroscopy (low energy x-rays). Occasionally, catheters are inserted via veins into the side of the neck, upper chest, or arm. The doctor will test various parts of the heart and usually will try to provoke the arrhythmia.
The sections of the heart that are causing your arrhythmia can be identified. The doctor will then use the radiofrequency energy (or cryoablation) to treat the problem area. During the procedure, your heart rate and rhythm, oxygen level, and blood pressure will be monitored.
When the procedure is completed, the doctor will again try to provoke the arrhythmia. If it cannot be induced, the procedure is considered to be a success. However, if the arrhythmia can still be induced, additional radiofrequency energy is delivered."

My friend won't know if surgery was a success, until two weeks after the surgery.  They did say they thought the surgery was a terrific success, but time will tell.  If you are experiencing any heart problems, it is vitally important to see your doctor or a heart specialist (cardiologist).  Our heart is one of our most important organs, so it is important to take care of it. 

Love your heart

and it will love you back.