SVT or Anxiety: My Racing Heart.

SVT or AnxietyTo all my fellow anxiety sufferers, a racing heart is just part of the package deal. And as annoying as it is, it’s always controllable by relaxing and distraction. At least in my case. I don’t take medication, because it’s not that bad. Yeah, I know. It’s incredibly annoying when people say you can stop anxiety in 3 simple steps. Just relax! Ugh. But what isn’t always controllable is SVT, also called Supra-Ventricular Tachycardia (SVT). This is what I found out I had the hard way.

For years, I had complained that my heart would have a “power beat”. I called them power beats because it felt as if my heart was launching out of my chest. When I told my primary care physician that I was having these strange heartbeats, he told me it was anxiety, because as is always the case, whenever I went to see him, they never occurred and my heart behaved itself.

About a year later, my heart did something absolutely terrifying. While at work sitting at my desk, it did one of those power beats and right after that, immediately started beating consistently at 168 bpm. I was on the phone at the time and excused myself from the office. I went out to my truck to try and relax, hoping to hell the doctor was right, in that it truly was anxiety. After about 45 minutes of consistently beating at 168 bpm, it returned to normal just as fast as it started (with a power-beat, or as I now know them to be a PVC). I went back into work and finished my day.

I went back to my doctor and once again, he told me it was anxiety. He hooked me up to an EKG and reassured me my heart was fine. There was no evidence of a heart attack or any heart damage. Relieved, yet discouraged, I knew something was not right.

My family also thought it was anxiety, which made things frustrating. Yes, I do suffer from occasional health anxiety, but this was something completely different and not normal, a common saying of any anxiety sufferer. It made discussions difficult because they thought I was simply in denial.

Well, it wasn’t more than about a month later that I had the same exact thing happen, again while at work. This time I raced to my truck and headed to my primary care physician. But as I was driving down the highway, it once again went from exactly 168 bpm down to 85 bpm (probably a bit high because I was once again terrified). I was convinced there was something not right, but no one was believing me.

I also started noticing that it was happening more often, and the episodes were lasting longer. It happened again, and again, and again. Each time I tried to calm myself by finding a quite place and repeating to myself “I’m not dead, I’m not passing out, I’m not in pain”.

Around the tenth time it happened during a 6 month period, I once again raced to my primary care physician and in fact made it to his office (45 minutes later I was still in SVT). He was at lunch and the receptionist recommended I drive myself to the ER. I thought, “Jesus, I’m dying and they are letting me drive?”. So off I went to the ER.

Now, when you go to the ER and explain to the receptionist you’re having heart issues, they don’t mess around. You get admitted right away. I told the nurse my heart was beating extremely fast. She asked the usual questions, “Are you using drugs? Have you drank caffeine? Are you on any medications?” The answers were all no. At first she didn’t believe that my heart was beating at 168 bpm, but as soon as she hooked me up to the heart monitor, she said “wow”, and I was escorted into the back room.

Even after they attached twelve leads to my chest and arms from the real-time EKG monitor, my heart was still racing at exactly 168 bpm. After about 15 minutes, the ER doctor came into my room. He asked me my name, asked how I was feeling and looked at the EKG. By now, I had been in SVT for about 2 hours, but surprisingly I felt fine. However, I was really nervous. He stood there silent for about 10 seconds as he looked at the EKG monitor, then said matter-of-factually “I know what this is … this is SVT”. What the heck was SVT, I asked? Is it related to anxiety? He smirked and emphatically said “no, absolutely not.” He went on to explain what it is and that it is NOT life-threatening, but can be horribly annoying and debilitating in some people. Still uncertain, I was wondering is this really SVT or anxiety (that’s the anxiety talking because the ER doctor just flat out said with 100% certainty it’s SVT)?

He spent close to 30 minutes explaining what it was. Reassured me time and time again that it’s not dangerous. But, since I had been stuck at 168 bpm for hours, he decided to give me an IV injection of Adenosine, and literally before the nurse finished injecting the drug, my heart skipped a beat and was immediately back down around 90 bpm. Again, probably a little high due to the stress I was experiencing. After monitoring me for 45 minutes (and waiting for the ER discharge papers), he sent me home with a couple Xanax to calm my nerves. He also referred me to a cardiologist and said to make a follow-up with them within the next couple weeks, but again assured me this was not a life-threatening issue. He also showed me some techniques to stimulate the sympathetic nervous system, which can stop the SVT (didn’t work in my case).

SVT or anxietySo what is SVT? I don’t have the credentials to explain it thoroughly, so I recommend Googling it. But to try and sum it up, it’s a short circuit between the top atrial chambers of the heart and the bottom ventricular chambers. There is something called the AV node, which slows the electrical impulse in the top of the heart from traveling to the bottom chambers of the heart. This is what causes the lump-thump, lump-thump and prevents all four chambers of the heart from contracting at the same time. In SVT, there is a connecting alternate route, usually shorter in distance (see picture to the left), or a second AV node.

What happens with SVT is the electrical signal gets stuck going around the two paths, which causes the heart to beat rhythmically, but just much faster. In doing so, the short-circuited path hijacks the normal sinus rhythm. Depending on how short the secondary pathway is, the heart will either beat fast, or really, really, really fast. My cardiologist told me some people hit 260 bpm, which can cause them to pass out. I was at a 168 bpm which is the heart rate many experience when doing strenuous exercise, so it wasn’t debilitating at all. Just incredibly scary and annoying.

There was no way I was waiting two weeks to call the caridologist. The next day, I immediately made the call and set up an appointment. Turns out they had a cancellation and I was able to squeeze in a few days later. I ended up speaking with the top electrophysiologist cardiologist in Colorado the next day, and after looking at my EKG charts confirmed it was SVT and NOT anxiety. To be more specific, he said it was AV Nodal Re-entrant Tachycardia (AVNRT). He said I can learn to live with it, and reassured me that it would not kill me. Or, I could go on medication (which has side effects), or ablate it. He also gave me the same tricks as the ER doctor to try and shut it down.

I was both relieved to hear this, but also worried. I could not live with this as it was causing huge anxiety issues. I was afraid to drive, leave the house, or do anything strenuous. Over the course of the next 6 months, it happened about 6 more times, one of them requiring another ER visit, another $150, and an IV of adeonsine because it wouldn’t stop after 4 hours. I was able to shut it down once using the blow-into-a-fist trick.

I made up my mind. I wanted this fixed. So I tried a medication called Verapamil, but this actually caused it to happen more often, and only when sitting down (probably because my blood pressure dropped while sitting). The cardiologist then recommended I go for a cryo-ablation, which is more safe than a Radio-Frequency Ablation, for the fact with cryo-ablation they can slightly freeze the pathway to make sure it’s the right one, stop the electrical signaling, then deep freeze it if all looks good. This permanently ablates, or kills, the secondary pathway. If it’s not the right area, they can let it thaw and it’s back to normal. You don’t want them to make a mistake when burning pathways in the heart. Doing so can result in a permanent pacemaker. There are no do-overs with RF ablation, because it burns, kills the cells, and thus scars the pathway on the first try.

Since he knew I was having issues with the anxiety associated with this, he booked me at the hospital the next day! God, I loved American healthcare (before ObamaCare). It was supposed to start around 11:00 am, but the woman getting ablated before me ended up having not only SVT, but also VT (which is the bad one). Therefore, he didn’t get to me until 5:00 pm. The procedure took 2.5 hours and was minimally invasive. One electrical lead up through a vein in the leg, and the other through a vein in the arm. No sedation, not cutting, no sutures. During the procedure, they deliberately make your heart skip beats and try to induce SVT. This allows them to map out the electrical paths. Felt like my heart was fluttering in my chest. Once they map out and isolate the alternate path, they ablate it.

I ended up having to stay overnight because they didn’t finish until after 7:00 pm (some policy at the hospital). The electrophysiologist stopped by twice, both times assuring me it was cured. The next morning I went home, feeling 100% normal. On my way out, he again reassured me that it was a complete success and that I would have no recurrences. The surgery took place on May 5th, 2009.

It’s been 8 years and I think I had two similar SVT type things happen, but they were not the same. One time I was bending over and my heart rate immediately shot up to 145 bpm, but then slowly went back to normal over the course of about 2 minutes. It didn’t feel like SVT, but it was close. The cardiologist thinks that might have just been an ectopic beat that temporarily took over sinus rhythm. Again, not life-threatening and fairly common in all people. Or, it could have been anxiety for all I know (I was stressed at the time). The second time just felt like a bunch of PVCs in a row.

I’m 41 now and I started having SVT when I was around 32 years old. I would say the cryo-ablation was a huge success and I am super glad I did it. My anxiety is still there, but occurs nowhere near as often or as strong as it was before I knew what was going on with my heart. I finally had a solution to my #1 stressor that did in fact turn out to be “something”, and when my heart does start racing, I do get nervous that it’s SVT again. As I write this, I have some sort of sinus infection, a fever and I’m on amoxicylian, which is causing my heart to stay racing at 100 to 120 bpm.

I don’t want to discourage any anxiety sufferers who regularly get racing heart beats. It does not mean you have SVT. If the racing comes and goes over a period of second or minutes, it’s probably not SVT. My SVT started literally in one heart beat; normal pulse 70 bpm, PVC, then 168 bpm and constant. No variation at all. If you do have the same issue I was having, see if you can get a 24-hour or 30-day holter heart monitor. It records all the electrical signals of the heart so the doctors have a continuous record of activity.

The frustrating part is, a full heart stress test may NOT induce SVT no matter how many times you get one done. I got the whole nuclear, barium, dopplar, echo-cardiogram stress test and they never found anything wrong. The only way they will know you had an SVT episode is monitoring your heart while it’s happening. SVT causes no damage or evidence of occurrence. They saw mine because I rushed to the ER and they got me hooked up to an EKG while it was happening. Before that, everyone thought I was nuts and that it was just anxiety.

Now, here’s the crazy thing I didn’t know until I was in my late thirties. My father also has these “strange racing heart symptoms”. He calls them double beats, in which his pulse jumps to 150 bpm in the same manner mine would. He however doesn’t have anxiety and has lived with the episodes for decades (he is now 69). He also has episodes that last upwards of 4 hours. Turns out SVT is hereditary, with a 25% chance of occurrence in a child who’s parent also had SVT. His cardiologist also confirmed it is not a life-threatening condition. If only he had said something to me earlier on, I wouldn’t have been so freaked out!

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