Heart & Cardiology/SVT Episode

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I am a 32 yr old female, 5'5 180lb bp 120/80. I started having a fast heart rate at 15. I was always told it was "panic attacks". It would happen every so often usually lasting 30 seconds to 5 min normally, but had been as long as 45 min at the most. I decided to get it checked out after having a child, and realizing nothing was actually "triggering' it. I was diagnosed at 27 with SVT by a cardiologist after using an event monitor. He put me on Toprol 50mg, and it seemed to keep it at bay. After a few months, I found out I was pregnant, and stopped the medication. After my son was born, I hadn't had any SVT episodes the entire time i was pregnant, or for 3 months post, and seen the cardiologist. He told me as long as i felt i was ok, i didn't need to start taking the toprol again, that if it started acting up, i could go back on them anytime. That was 5 yrs ago. I've had the occassional episode lasting 3 min or less maybe a few times a yr since then, not enough to prompt me to start meds again. 3 days ago, i came home from the grocery store, and had a short episode that evening. I went to bed, and woke up to an episode at 2 am. it lasted about 5 min, then another woke me at 4 am, only that time, it wouldn't stop. after each cycle of the beating, it would suddenly stop, return to normal for a second or 2, then jump right back into SVT cycle. this went on til 11 am! Normally I use deep breathing to stop the episodes, but it wasn't having any effect. I had never before been scared of this before, but it scared the heck out of me! I had NEVER had this go on for so long. When it finally stopped, i had a continuing "flutter" feeling that lasted for hours and was weak & exhausted the rest of the day. i would think it couldn't keep beating like that...my dr said it wasn't life threatening, but never mentioned what to do of the possibility that it may not stop. My question is, will this always stop on its own? and what should i do if it doesn't stop? how long can it go on for? this really worried me. Thanks.

Answer
Hello Teresa,

SVT can continue for hours, even a few days.  Here are some ways to stop it.

Maneuvers to stop SVT

Lie down for 5 minutes.  If in airplane, lie as flat as you can get the seat.
Still lying down, do a Valsalva maneuver.  Take a breath in, then exhale but donít let air escape from your chest.  Close mouth and hold nose if necessary.  Strain down hard as if to move bowels for about 5 seconds.
Repeat above once.
Massage a carotid sinus.  The carotid sinuses are on either side of the windpipe and a little behind it.  Rub firmly on one carotid pulse as high in your neck as you can feel the pulse for about 3 seconds.  If that fails, rub the other sinus firmly for 3 seconds.  If that fails, rub both simultaneously for about 3 seconds.
If all that fails, ask your doctor to see how well youíre doing the Valsalve and to mark where in your neck the carotid sinus are likely to be.
If all that fails , consider medicines like flecainide or verapamil, and if they fail to control the SVT, consider ablation.

Can you restart the Toprol?

Please write back if this note doesnít answer all your questions.

David Richardson

Heart & Cardiology

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David Richardson

Expertise

Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.

Experience

Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Organizations
Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Publications
Circulation, American Heart Journal, Hypertension.

Education/Credentials
M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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