SVT or Anxiety: My Racing Heart.

To 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 single “power beat” every once in a while. 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. Just as a car never makes that strange noise when you take it to the mechanic, my heart behaved itself and never had one of these power beats while at the doctor office.

The Beginning

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 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, an irregular heart beat, or any heart damage. I knew something was not right.

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

Again, and again, and again …

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). Now I was absolutely convinced something was not right.

Worse yet, it started 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, I’m still alive”.

However, one time it started and didn’t stop. I once again raced to my primary care physician and actually made it to his office 45 minutes later. 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.

Race to the Hospital

Now, when you go to the ER and explain to the medical staff working the counter that 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. They 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. Shortly thereafter, 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 normal (aside from the fast heart rate). I wasn’t in pain, wasn’t light-headed, wasn’t numb, had no tingling, and could think perfectly fine.

I was however, really nervous. My health anxiety was convincing me I had some terminal heart issue and was going to end up needing a heart transplant.

The Doc stood there silent for about 20 seconds as he looked at the EKG monitor. Then said matter-of-factually “I know what this is … this is SVT”. What the heck is 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 even debilitating in some people. Still uncertain, I was wondering is this really SVT or something more deadly. Of course, that was the anxiety talking because the ER doctor just flat out said with 100% certainty it’s SVT.

He spent close to 30 minutes explaining, and re-explaining what it was. He even grabbed a fake heart from another room to visually show me what was going on. Time and time again he reassured me that it’s not dangerous. He had be blow real hard into my first, cough real hard, bend over and a few other things called vassalage maneuvers. These sometimes can cause the heart to reset.

After those failed, and since I had been stuck at 168 bpm for hours, he decided to give me an IV injection of Adenosine. Literally before the nurse finished injecting the drug, my heart skipped a beat and was immediately back down 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. As he walked out the room, he again assured me this was not a life-threatening issue.

Supraventricular Tachycardia

SVT or anxiety

So what is SVT? I don’t have the credentials to explain it thoroughly, so I recommend Googling it. But, it stands for Supraventricular tachycardia. 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 an alternate route, usually shorter in distance, 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.

The Electrophysiologist

There was no way I was waiting two weeks to call the cardiologist. 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 in Colorado the next day. After looking at my EKG charts from the hospital, 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. I could go on medication, which has side effects. Or, I could ablate it. He also gave me the same tricks to stimulate the parasympathetic nervous system as the ER doctor to try and shut it down.

I was both relieved to hear this, but also still horribly worried. There is no way 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 adenosine. It wouldn’t stop after 4 hours. I was able to shut it down once using the blow-into-a-fist trick.

My mind was made up. I wanted this to stop. So I tried a medication called Verapamil, but ironically, this actually caused it to happen more often. It was odd, but any time I sat down, it would kick in. Doc thought it had to do with my blood pressure dropping. The medication lasted about 2 days.

The Cryo-Ablation Procedure

The cardiologist then recommended I go for a cryo-ablation, which is more safe than a Radio-Frequency Ablation. With cryo-ablation, the doctor can slightly freeze the pathway to make sure it’s the right one. This stops  the electrical signaling, but doesn’t kill the cells. If all looks good, then they can deep freeze the spot and kill the cells. This permanently ablates, 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, no 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. Man, that was awful. Felt like my heart was fluttering in my chest. But once they map out and isolate the alternate path, they know what to ablate.

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 I 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.

All Is Well

It’s been 10 years and I think I had two similar SVT type things happen. However, they weren’t quite 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 felt like SVT, but unlike before, the hear rate slowly went back to normal rather than suddenly. 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 started having SVT when I was around 32 years old. I’m now 44. 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 amoxicillin, 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.

Family History

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 describes them as double heart beat. His pulse only reaches 150 bpm in the same manner mine would. However, he doesn’t have anxiety and has lived with the episodes for decades (he is now 74). His episodes also last upwards of 4 hours. Turns out SVT is hereditary, with a 25% chance of occurrence in a child who’s parent also has 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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