SVT out of the blue, went to the ER (insert grumble words here)

Hi, Everyone,

Background:
I was hospitalized for a-fib, out of the blue (again, this out of the blue) a couple of years ago. Calcium channel blockers did nothing, but finally, increased doses of beta blockers got me back in rhythm.

So all was going well and today I did errands. Because of parking issues, I ended up walking from my parking spot to where I needed to go, and back again--and it was hot today if that makes any difference. Since I'm monitoring my diet and exercise, I noted that the walk was a little less than half a mile. No big deal. Did one more errand, came home, sat down with some chicken and green beans and all of a sudden, I started feeling that quivering in my chest.

I tried coughing, putting my face in ice water, drinking ice water, putting icy cold cloth around my neck, holding my breath on an exhale, holding my breath on an inhale, and the problem persisted. I asked DH to drive me to the ER, where I was seen immediately as soon as I walked up to the window (apparently, pale, wobbly and short of breath does the trick).

They slapped EKG leads on me, asked some questions, I told them I was hospitalized once for a-fib a couple of years ago, and they took one look at the screen and announced I was in SVT ! They did the first & second attempt at stabilization with a vagal maneuver ("push" and my legs quite elevated by a member of the medical team)--nope, that did nothing.

Then they tried the lowest dose of Adenosine, and that worked BUT they still wanted to watch me carefully so they said "We'll put her in the code room." I said I know what that means, but they said it doesn't mean that right now.

I didn't need another dose of Adenosine, but I asked about the progression for treatment. There was a second dose or Adenosine if needed, then if that didn't work, they'd try a different medication, and if that didn't work, then electrocardioversion.

Questions:
1) Is it "normal" to have a-fib and then get SVT??
2) Is there any way at all to try and stack the deck to avoid SVT? (I don't smoke anything, I don't vape, I don't drink alcohol or tea or coffee or soda and I don't use salt)
3) Are there any other vagus nerve techniques I might try, and in your opinion, how successful are they? ...and if they are successful, do you just start up again with SVT within an hour or two or ?
4) Would my half a mile walk in the heat possibly triggered the SVT an hour later? (I try to walk every day and can easily do half a mile)

I was really scared

Thanks for any input and words of wisdom. I'm kinda afraid to go to sleep, y'know, for fear of having this for hours when I sleep before I actually wake up to it!!!
Thank you!

Edited due to spelling or grammar errors and because I forgot to say THANK YOU!



Edited 3 time(s). Last edit at 07/17/2019 04:37AM by SueChef.

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SueChef
Questions:
1) Is it "normal" to have a-fib and then get SVT??
2) Is there any way at all to try and stack the deck to avoid SVT? (I don't smoke anything, I don't vape, I don't drink alcohol or tea or coffee or soda and I don't use salt)
3) Are there any other vagus nerve techniques I might try, and in your opinion, how successful are they? ...and if they are successful, do you just start up again with SVT within an hour or two or ?
4) Would my half a mile walk in the heat possibly triggered the SVT an hour later? (I try to walk every day and can easily do half a mile)

1) The two conditions aren't really connected, so it's nor normal or abnormal. You're just unlucky.

2) No, not really.

3) In my EMS days we always had patients try to exhale as forcefully as they could against closed lips. Sticking your thumb in your mouth and trying to blow against it is an easy way to do that. The SVT might start again later or it might not. It's like afib in that regard: it starts when it wants and usually for no apparent reason.

4) Not likely.

The fact that adenosine terminated it is diagnostic for atrioventricular nodal reentrant tachycardia (AVNRT, the most common) or atrioventricular reciprocating tachycardia (AVRT). Both are similar and involve signals conducting backwards from the ventricles back to the atria, setting up an endless loop. It's similar to atrial flutter in that way. Both are most common in younger women. Treatment is usually verapamil, but ablation is the ultimate cure. It's a much simpler ablation procedure than afib.

What you need to do first is see an EP to get an overall workup and make sure nothing more serious is causing it. Wolf-Parkinson-White syndrome, for example (but that's unlikely because the ER docs would have recognized that). The EP can get you started on verapamil and then you can talk about ablation.

Thank you so much for this helpful information, Carey!

Is there a good chance that this was a one time thing or is that quite unlikely?

Sue:

You said you don't use salt, you really need salt, the right kind like Celtic Sea Salt, not the one in the blue box. If you were walking and it was very hot, you need salt.

Liz



Edited 1 time(s). Last edit at 07/17/2019 02:20PM by Elizabeth.

Can’t comment on Afib but I would change your diet a bit. Low salt diets in general are dangerous imo, everything starts cycling through your body so no matter how much potassium or magnesium you’re taking you’re just flushing it out. It never reaches your heart. I limited my salt intake for a year and never felt worse, tired, shaky and even started getting short runs of arrhythmia like svt. I would urinate 20 times a day until I figured out the issue. Solved with increased salt intake in the morning and afternoon, much more energy and no more constant flushing of electrolytes. I would increase the use of pink salt or sea salt to around 3 grams a day and go from there. It’s the processed food salts and the sugars you need to watch out for. For thousands of years prior to refrigeration people were curing everything with salts and consumption was much higher and some countries still do this, totally normal and healthy.

Here’s an article you might find relevant.

[www.health.harvard.edu]

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SueChef
Is there a good chance that this was a one time thing or is that quite unlikely?

Sorry, it's unlikely to be a one-time thing. Like I said, the fact that adenosine terminated it is diagnostic, and AVNRT/AVRT doesn't just go away on its own. But it's certainly possible that episodes will be rare and another one might not happen for a very long time.

I have a call in to my EP's office and they're supposed to call back within 24 hours so I can set up an appointment.

Thanks, Liz, for the recommendations. As for salt, I don't salt my food. I figure there is enough sodium in the foods I usually eat. We do have some Himalayan pink salt and some Trader Joe's Mediterranean sea salt, and Alaea Hawaiian salt in the cupboard--- guess I should maybe start adding a dash of salt to my food.

JohnnyS, I haven't salted my food for decades and my tastebuds seem to notice the saltiness of foods rather quickly. I do use both salted and unsalted butter in very strict moderation in my diet--salted butter, yeah, that counts! It's medically necessary for me to have salted butter on stuff, right? ha ha

Carey, thanks again for your being upfront about the likelihood if SVT (AVNRT/AVRT) repeating itself. I did ask the ER doc about medications that might help me avoid these episodes, maybe a "pill in pocket" med, and he said they don't really prescribe these. I appreciate your words that it's possible this is rare for me. That gives me hope versus living in fear of driving somewhere by myself, being alone when DH is at the ball game, etc.

Thanks again!
Sue

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SueChef
I did ask the ER doc about medications that might help me avoid these episodes, maybe a "pill in pocket" med, and he said they don't really prescribe these.

The ER won't prescribe something like that because ER docs rarely prescribe anything to be used outside the hospital, but your EP probably will.

Thanks, Carey!