Just had a recent event and was diagnosed with Supraventricular Tachycardia (SVT). It scared the **** out of me, but apparently is fairly benign condition.

Scary part:
- Heart Rate 200 bpm
- Blood pressure normal
- moderate Chest pain

Went to the ER (currently in a foreign country) and they performed a "vagal maneuver" which basically put pressure in my chest cavity through me blowing real hard and then flipped me on my back with my legs in the air.

Within 2 seconds the chest pain was gone and my heart rate was back down in the upper 80s.

I've been wearing my Apple Watch religiously since then and checking my heart charts; all normal 60-70 bpm since Sunday.

Bloodwork all came back normal; no heart attack markers or anything.

Apparently this can be triggered by alcohol, caffeine, spicy food, lack of sleep, stress… and I probably had all 5 within the last week; so just trying to relax and change some eating habits and hope that alleviates any future episodes.

Scary as hell though.

Not my area of expertise, but you need to see an EP (electrophysiologist). This is far from a benign condition and can result in fatal arrythmias especially if you have an aberrant pathway that is bypassing the vagal canal.

From an AI Query as I just know to find these and punt them to cardiology asap:

The treatment protocol for new onset supraventricular tachycardia (SVT) typically follows a step-wise approach, starting with non-invasive methods and progressing to more intensive interventions if needed:

1. Vagal Maneuvers: These are recommended as the initial treatment for hemodynamically stable patients with regular SVT[1][2]. Techniques include the Valsalva maneuver or carotid sinus massage.

2. Intravenous Adenosine: If vagal maneuvers are unsuccessful, adenosine is the first-line pharmacological agent for acute termination of SVT[1][2]. It has a quick onset and short half-life, making it highly effective and safe.

3. Calcium Channel Blockers or Beta Blockers: If adenosine is ineffective, intravenous administration of diltiazem, verapamil (calcium channel blockers), or beta blockers like metoprolol can be used[1][2]. These medications achieve a longer-lasting AV nodal block compared to adenosine.

4. Synchronized Cardioversion: For patients who remain hemodynamically stable but do not respond to pharmacological treatments, synchronized cardioversion is recommended[2].

5. Other Antiarrhythmic Medications: In cases of wide complex tachycardia not resolved by adenosine, medications such as procainamide, sotalol, or amiodarone may be considered[1].

For ongoing management after the acute episode:

- Oral medications: Beta blockers, diltiazem, or verapamil can be prescribed for symptomatic patients without ventricular pre-excitation[2].

- "Pill-in-the-pocket" approach: For infrequent but prolonged episodes, patients can be taught to self-administer oral medications as needed[1].

- Catheter Ablation: This procedure is recommended for long-term management in many cases of SVT, particularly for AVNRT, focal atrial tachycardia, and AVRT[2].

It's important to note that treatment should be tailored to the specific type of SVT, the patient's hemodynamic stability, and any underlying conditions.

Citations:
[1] https://www.aafp.org/pubs/afp/issues/2015/1101/p793.html
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC5135523/
[3] https://jamanetwork.com/journals/jamacardiology/fullarticle/2527088
[4] https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2019/09/10/12/36/2019-ESC-Guidelines-for-Supraventricular-Tachycardia
[5] https://www.ahajournals.org/doi/10.1161/cir.0000000000000311
[6] https://www.ncbi.nlm.nih.gov/books/NBK441972/
[7] https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/supraventricular-tachycardia/treatments.html
[8] https://www.rch.org.au/clinicalguide/guideline_index/supraventricular_tachycardia_svt/

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Answer from Perplexity: pplx.ai/share

I think wearing the Apple watch is a good idea, they can detect fast heart rhythms decently well.

Learning vagal maneuvers is good first aid, but you need to see ER care if they don't work. Medicines are the next step after that.

Agree with seeing an EP - electrophysiologist.

I was born with SVT.

NICU for a couple days.

It game back when I was 28 through stress from the Army…amongst other things. I had a catheter ablation done in 2017 and that solved that issue. No more drinking or high amounts of caffeine.

My wife is a PA and I remember her listening to my heart after I said I was feeling out of breath and my heart was fluttering. The doctor said I'll have afib every now and then. Which is true every now and then.

I remember going to the troop clinic and the nurse freaked out and almost sent me to the ER after listening to me and getting an EKG. The cardiologist gave me some cardizem (not sure the exact spelling) for the condition until I had my procedure. Only stayed one night in the hospital. They knock you out, send some wires up your groin area and melt some heart tissue and bang you are all fixed up.

Happy to answer any other questions

You're thinking children where incidence of AVRT is significantly more common than AVNRT when compared to adults as the etiology for SVT. New onset SVT in adults is rarely secondary to AVRT (SVT caused by accessory pathways). No need to freak the guy out. New onset SVT in adults is, as you were informed, generally benign in adults. A smart watch is an excellent thing to have on you at all times.

The maneuver they performed is what's called a modified valsalva. It has increased efficacy over normal valsalva maneuvers. My suggestion would be to teach family members how to help you perform this maneuver in the future (there are YouTube videos explaining the technique), as well is brushing up on additional valsalva maneuvers that you can perform on yourself when you're alone. Call 911 if those don't work though.

Definitely get an appointment with an electrophysiologist, but no need to stress too much about this. There are options like ablations if this becomes a recurrent issue.

Thanks, going to Cardiologist today; will nail it down in short order.

Agree that in adults this is typically benign that needs no treatment (especially when you might have identified 5 different causes). It would warrant some basic testing but assuming that was OK, for an isolated episode I typically wouldn't do anything more than monitor.

Cleared by the cardiologist; no restrictions.

Gave Metoprocol? 50mg in case Vagal Maneuver doesn't work in the future.

That's a weight off

Happy for you.

Live in moderation sir.

I got into this problem a couple years ago at age 48. It started in the fall, and I remember the first time being during an Aggie game which is not too surprising. HR went to 160 and stayed there for a couple hours. Went to the ER and they got it to go down with a drug, forget which one. Actually sent me to the HR in a bigger city which was not necessary but the small town ER doctor thought I was at risk for a stroke.

I start having these racing heart episodes about once a week usually right at bedtime when I laid down in bed.

I got scheduled with a cardiologist. I've been to 2 different cardiologists and I have a low opinion of cardiologists now. The first did an EKG, listened to me describe my symptoms and prescribed a couple pills. Pills had no effect. HR was spiking once or twice a week. Changed dosages, still no effect. Doctor #1 next step was another drug. This drug requires a hospital stay for a couple of days to make sure you don't die. I said no thanks and found another doctor.

Doctor #2 comes recommended from several people. He doesn't even do an EKG. Listens to symptoms and looks at the chart and prescribes a couple different drugs. He says that they probably won't work and he's right. His next step is an ablation and puts me on the waiting list which is 3 months out.

I go in the meantime to my wife's doctor. She is the kind of doctor that tends toward natural remedies. Does not take insurance. Big on supplements. She actually does some investigation vs just prescribing drugs. Blood work shows hyperthyroid and she puts me on levothyroxin along with a long list of vitamins and supplements. Heart problem stops after a couple of weeks. I've had 2 episodes in the last 12 months. I take propranolol if I have one and it seems to work after about 30 minutes. She saved me from a risky heart drug and an ablation.

Jack Boyett said:

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I got into this problem a couple years ago at age 48. It started in the fall, and I remember the first time being during an Aggie game which is not too surprising. HR went to 160 and stayed there for a couple hours. Went to the ER and they got it to go down with a drug, forget which one. Actually sent me to the HR in a bigger city which was not necessary but the small town ER doctor thought I was at risk for a stroke.

I start having these racing heart episodes about once a week usually right at bedtime when I laid down in bed.

I got scheduled with a cardiologist. I've been to 2 different cardiologists and I have a low opinion of cardiologists now. The first did an EKG, listened to me describe my symptoms and prescribed a couple pills. Pills had no effect. HR was spiking once or twice a week. Changed dosages, still no effect. Doctor #1 next step was another drug. This drug requires a hospital stay for a couple of days to make sure you don't die. I said no thanks and found another doctor.

Doctor #2 comes recommended from several people. He doesn't even do an EKG. Listens to symptoms and looks at the chart and prescribes a couple different drugs. He says that they probably won't work and he's right. His next step is an ablation and puts me on the waiting list which is 3 months out.

I go in the meantime to my wife's doctor. She is the kind of doctor that tends toward natural remedies. Does not take insurance. Big on supplements. She actually does some investigation vs just prescribing drugs. Blood work shows hyperthyroid and she puts me on levothyroxin along with a long list of vitamins and supplements. Heart problem stops after a couple of weeks. I've had 2 episodes in the last 12 months. I take propranolol if I have one and it seems to work after about 30 minutes. She saved me from a risky heart drug and an ablation.

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Glad it's settling down.
One of the reasons we check thyroid labs too when people come into the ER with arrhythmias.
We also talk about stress, fatigue, sleep habits, caffeine, alcohol and drug use for the same reasons.
All are moderate to high risk for these heart rhythm problems.

I guess this is a good story to see your FP/Imed first. Specialists tend to think about their speciality and not much else. As a pedi I always get thyroid studies on patients with tachycardia arrythmias.

Wife had this and about 10 years ago had catheter ablation via the femoral artery. Surgery was maybe 2-3 hours at the Baylor heart hospital and she went home the next day. She has never had another incident and is very happy with the results.