You might be right, the PSVT has not been offically diagnosed
as such. It is something my Doctor mentioned that may occur and
has matched the usual symptoms of PSVT, at least what I’ve read.
It certainly isn’t anxiety, the first episode was worsened by it, but
the other episodes I was calm and relaxed. However if you say that
PSVT must start and stop suddenly, then maybe I have something else.
All I can say is that one minute it’s normal and within 30 seconds or
so it would be at least 160BPM, then it would drop a little, then disappear.
Chest tightness, shortness of breath, and lightheadedness were present
two of the four episodes. Also, FWIW, extreme fatigue occurred after all
four.

>In case you missed it, read the following warning from Rod Venger
><ven…@earth.usa.net>:

>>Word to the wise: Don’t use carotid massage without talking to your
>>doctor first and whatever method you use to induce a vagal response,
>>NEVER do it while standing. A precipitous drop in heart rate of 100+ BPM
>>can have predictable results. -Rod-

Right, I read such warning on the web page http://www.familyinternet.com, which,BTW,
has some good reading material on cardio and other medical information.
I tend to use cold water on the face and neck when I encounter any uncomfortable
heart conditions. Holding my breath for a few seconds here and there would help
some, but the cold water feels best.

Ticker writes:
>In article <4vavce$…@vixen.cso.uiuc.edu>, a-…@staff.uiuc.edu says…
>>The PSVT episodes could be triggered by your irregular beats, and it’s
>>possible that they could also be induced by exercise.
>It’s triggered by irregular beats. I would be okay one minute, then
>I start feeling an odd sensation deep in the chest like tapping, then
>little by little the heart rate will rise until it reaches it’s climax
>of about 160-180BPM, then slowly drop back down to normal. The whole
>episode usually lasts no more than 5-10 minutes.

If your heart rate rises and drops slowly, then it’s probably not
PSVT since, by definition, paroxysmal SVT start and stop suddenly.

In case you missed it, read the following warning from Rod Venger
<ven…@earth.usa.net>:

- Hide quoted text — Show quoted text -

>Word to the wise: Don’t use carotid massage without talking to your
>doctor first and whatever method you use to induce a vagal response,
>NEVER do it while standing. A precipitous drop in heart rate of 100+ BPM
>can have predictable results. -Rod-

Presumably you’ve had ECGs recorded and examined for possible
manifestation of Wolff-Parkinson-White (WPW; an accessory pathway,
which helps sustain the PSVT).  It’s possible that the WPW will not
show itself in every ECG.  You probably don’t have an ECG of your
PSVT; that would also be of diagnostic value.

(I have WPW.  My first ECG was normal.  The ECG that recorded my PSVT
had some nonspecific ST-T wave changes, but otherwise looked normal.
It was 2 years later that an ECG during sinus rhythm showed the
telltale "delta wave" of WPW.)

The PSVT episodes could be triggered by your irregular beats, and it’s
possible that they could also be induced by exercise.

When you experience your next PSVT, you might try the following
"vagal stimulations" in an attempt to terminate the rhythm:

  [from, "Understanding Electrocardiography" (Conover), p322]

  Both carotid sinus massage and gagging are strong vagal
  maneuvers.  Others are squatting, leg elevation, blowing against
  a closed glottis, and cold water to the face.)  This maneuver
  should be performaed as soon as the tachycardia is recorded.
  The longer the wait, the more difficult it is to convert with a
  vagal maneuver because of the increasing dominance of the
  sympathetic nervous system.

Albert

- Hide quoted text — Show quoted text -

Ticker writes:
>No medication has been prescribed. The PSVT has only occurred 4 times,
>the first in February, which was the worst. The other three being within
>the last 6 weeks. I’m not too concerned over the PSVT since it occurs
>very infrequently, lasts only a short time, 5-30 minutes, and is only
>uncomfortable if the anxiety that accompanies it gets the best of me,
>otherwise I just sit back, relax and wait for the tachy to return to normal.

Something that has worked for me a couple of times is doing a shoulder
stand for 10-15 seconds.  That shortens the attacks sometimes.

I would avoid medication if you can help it and are feeling good
otherwise.  I’ve been on calcium channel blockers, beta blockers, every
possible combination of the two and now I’m on Tambacor and I *still*
get breakthrough attacks.  The side effects are no fun, though slightly
better than several attacks a week.

<sigh>  Time to get cracking on a second R-F ablation since my first one
failed…anyone had one done at the Health Sciences Center in Oklahoma
City?

–
[X] Molly Bowling

The day that this country ceases to be free for irreligion, it will
cease to be free for religion.            -Robert Houghwout Jackson

>From your description, during PSVT, you don’t appear to suffer symptoms
>other than the palpitation and slight anxiety (i.e., no shortness of
>breath or dizziness), which is a good sign.

Actually I failed to mention that two of the four PSVT episodes I’ve had,
shortness of breath, lightheadedness, and tightness of the chest were present.

>Presumably you’ve had ECGs recorded and examined for possible
>manifestation of Wolff-Parkinson-White (WPW; an accessory pathway,
>which helps sustain the PSVT).  It’s possible that the WPW will not
>show itself in every ECG.  You probably don’t have an ECG of your
>PSVT; that would also be of diagnostic value.

Well the first PSVT episode put me in the ER back in Feb., I was a
panic case at the time. Anyway, I had a 12 lead EKG done just as the
PSVT was going away.
The diagnosis was minor sinus tachycardia. A few months later I wore
a King of Hearts monitor for 4 weeks. Numerous episodes, skipped beats
and such, but no PSVT, were recorded and diagnosed as premature and
skipped beats. Actually one Cardiologist said I had a Quaduplet, while the
head Cardiologist said it wasn’t.

>(I have WPW.  My first ECG was normal.  The ECG that recorded my PSVT
>had some nonspecific ST-T wave changes, but otherwise looked normal.
>It was 2 years later that an ECG during sinus rhythm showed the
>telltale "delta wave" of WPW.)

This is interesting. I wonder what an ECG of mine would look like now.

>The PSVT episodes could be triggered by your irregular beats, and it’s
>possible that they could also be induced by exercise.

It’s triggered by irregular beats. I would be okay one minute, then
I start feeling an odd sensation deep in the chest like tapping, then
little by little the heart rate will rise until it reaches it’s climax
of about 160-180BPM, then slowly drop back down to normal. The whole
episode usually lasts no more than 5-10 minutes.

>When you experience your next PSVT, you might try the following
>"vagal stimulations" in an attempt to terminate the rhythm:

>  [from, "Understanding Electrocardiography" (Conover), p322]

>  Both carotid sinus massage and gagging are strong vagal
>  maneuvers.  Others are squatting, leg elevation, blowing against
>  a closed glottis, and cold water to the face.)  This maneuver
>  should be performaed as soon as the tachycardia is recorded.
>  The longer the wait, the more difficult it is to convert with a
>  vagal maneuver because of the increasing dominance of the
>  sympathetic nervous system.

Right, I’ve used a wash cloth soaked in cold water many times, PSVT or not.
Holding my breath helped some also.

>Albert

Thanks for the reply.

>From what I gether from your message there should be no problem for
>your health. Just one doubt about the opportunity of drug medication
>for your PSVT…. has your cardiologist prescribed any drug?

No medication has been prescribed. The PSVT has only occurred 4 times,
the first in February, which was the worst. The other three being within
the last 6 weeks. I’m not too concerned over the PSVT since it occurs
very infrequently, lasts only a short time, 5-30 minutes, and is only
uncomfortable if the anxiety that accompanies it gets the best of me,
otherwise I just sit back, relax and wait for the tachy to return to normal.

++++++++++++++++
From what I gether from your message there should be no problem for
your health. Just one doubt about the opportunity of drug medication
for your PSVT…. has your cardiologist prescribed any drug?
As far as the sensation of "forcefull heart beat" is concerned, this
is part of the symptoms due to your arithmia.

>Basically I’m alittle concerned over this murmur, because I can find no reference
>to a "healthy heart" murmur. The only thing I could find is an innocent murmur, which
>is common among infants. All the info I’ve read about murmurs is that they are not good.
>So do I have reason for concern?

Heart murmurs as a rule are not good, as you say.  However, there is
something called a "flow murmur" which is probably what your doctor is
referring to in your case.  This is not a true murmur in that it isn’t
caused by structural heart disease — valvular problems or holes in
the heart, for instance.  Basically, it is the same sound as is heard
in aortic sclerosis (or mild aortic stenosis) — a diamond-shaped or
decrescendo systolic murmur in the aortic listening area.  On echo,
there is no evidence of either aortic stenosis or sclerosis.  The
source of the murmur is thought to be the turbulence created by the
forceful ejection of blood through the aortic valve into the aortic
root.  Since it is not associated with any cardiac pathology, it is
not cause for concern.

>As far as my other conditions are concerned, the skipped or premature beats, occur
>about 2-5 times a week, lasting no more than 1-5 seconds. The PSVT has occurred 4 times
>since February, lasting about 5-30 minutes with a usual heart rate of between 140-190BPM,
>depending on the level of anxiety that occurs with it. I also have episodes of normal
>and steady, but very forceful heart beats that radiates into the neck, lasting about 30 minutes.

The initial approach to PSVT is indeed laying off stimulants such as
caffeine and nicotine.  Beta blockers are often used if the PSVT
continues to be bothersome.  If the PSVT is extremely frequent or
symptomatic, radio-frequency catheter ablation (a cath lab procedure)
is sometimes used to eliminate the source of the SVT.

>My cardiologist made no comment to this, but the info I’ve gathered calls this a
>"bounding(not pounding)heart beat, which is usually caused by excess fluids in the bloodstream.
>Can drinking 5-8 glasses of water a day cause this?

Nope.  Your kidneys will get rid of any excess water quite quickly.
The sensation of a pounding heart beat is usually either due to
bigeminy (PVCs alternating with normal heart beats) or nothing that
can be seen on Holter monitoring.  Since bigeminy (or trigeminy or
whatever) isn’t ominous, it’s usually best to try to ignore it.  :-)

– Chris

>Any feedback to the above would be greatly appreciated.

____________________________________________________________

 Chris Klugewicz
 Fellow, Div. of Cardiology
 University of Maryland               email: c…@chesbay.com
____________________________________________________________