Paroxysmal Supra-Ventricular Tachycardia (SVT)

Interested to hear how other runners cope with Paroxysmal Supra-Ventricular Tachycardia (pSVT / SVT).

http://www.merck.com/mmhe/sec03/ch027/ch027d.html

http://www.tetongravity.com/forums/showthread.php?t=89558

Looking back at my garmin data, I've had episodes in 4 out of 78 runs over the past 8 months ... the first two episodes were last year and happened during the (only) two times I'd run shortly after taking ibuprofen. The first was prolonged (happened twice on the same run, each for many minutes) but it was during my first race and at the time I assumed the perceived exhaustion was "race-related" and that the monitor readings were some artefact. The second was a very short episode on a slow run but I recall feeling suddenly "puffed out" for a minute or so before recovering. When I saw the heart rate trace later, it made me reconsider the first occasion ... and I've never taken ibuprofen again before a run as a precaution ... and thought that was that.

However, I've had two more events, one last weekend (two episodes in the same run) and one 7 weeks earlier. Inbetween these I set a 5K and 10K PB so I'm in reasonable shape. I was convinced after the first 2009 episode that it wasn't something artefactual about my monitor but was real ... I could tell when it happening before noticing the numbers on my garmin (I feel "drained/puffed out" almost as if I've just finsihed an interval sprint). After last weekend's 13 mile run, when it happened twice, I thought I'd better find out what's going on!

I'm 42, recent 44:36 for 10K and 21:42 for 5K ... RHR is 48 bpm and maxHR is 179 bpm... my episodes/events result in a sudden shoot from, say, 140bpm or whatever I'm running at,  to a riddiculous 220-230 bpm where it flucutates "normally", albeit with a new elevated baseline (i.e. they are not short-term "spikes"). As soon as the sudden collapse from this elevated plateau to the normal range returns, I feel fine.

I'm not sure what the trigger is yet ... it's not how hard I'm running as my recent races and interval sessions have been fine, as have most of my long/easy runs. I'd was pretty run down last week with a cough/cold and had consumed a box of lem-sips (maybe Morrison's own brand version)... I have spotted that non-prescription decongestants can be a trigger. I also drink too much coffee during the working day which is another potential trigger.

I realise from reading around that this is most likely pSVT and, if so, it's not a disasterous condition and is relatively common ... nevertheless, I'm obviously going to get it checked all out with my GP (and hopefully a cardiologist) but I always like to be prepared and do my research first (I'm a biologist not a clinician).

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Comments

  • My polar hrm gives me a reading of 260 bpm, everytime the strap works loose. (I'm a sparks not a clinician, Try new batteries in your garmin)

    and see the GP

  • SianceSiance ✭✭✭

    Switch to decaf image

    Not my area Dan as you know but I hope you get it sorted image

  • JJ2JJ2 ✭✭✭

    I get paroxysmal SVT & am a medic - GP not cardiologist. There are often compounds in cold & flu preparations that might exacerbate symptoms as can coffee. I find I get it if I'm about to get a viral infection but most episodes are unpredictable. Your symptoms seem to be quite frequent, I do think you should see your GP & get referred to a cardiologist to make a formal diagnosis & consideration of whether medication may be relevant.

    They will obviously want to know more than you have posted above especially family history, smoking,etc.

    Don't leave it - make an appointment soon & let us know how you get on?

  • Dr.DanDr.Dan ✭✭✭

    Thanks JJ2 - yes, don't worry I will certainly get myself seen! Is "4 events in 8 months" or "once every 20 runs" considered particularly frequent? I always wear a heart monitor but otherwise I may have missed some of these.

  • JJ2JJ2 ✭✭✭

    Not necessarily but are you only getting it during runs? I wouldn't make any assumptions till you are assessed. Probably will need ECG & echo as well as possibly a 24hr recording but it's so infrequent that they probably won't catch one.

    Most patients won't have a had a HRM on during an attack. I know I was fascinated when I did while using my Garmin so I could look at a download.

  • Dr.DanDr.Dan ✭✭✭

    Yes, I'm pretty sure I've only experienced this on those four occasions when it's happened while running. I obviously don't wear my HMR continually but I'm pretty sure I'd notice a 225bpm heart rate if it happened during the course of the normal day! But maybe I should wear my HRM for a few days just to see what happens.

    I too have the feeling it will be difficult to capture with a 24-hour Holter monitor  test ... I'll have to drink coffee, have an ibuprofen or lemp-sip ... and then go on a 10 miler. image

  • When I was having my problems DD (AF not SVT) I found that initially cutting out caffine, red wine and other stimulants cold remedies... other stuff; did the trick - at that time I was on a 70+ mile a week training regime and never had an incident whilst running (No Garmin - but I'd have looked at my Polar if I'd have felt anything unusual).  Mine happened in the dead of night... usually after my LSR and/or a session on the booze

    It was 3 years after my first flutters before the docs caught an attack on a 24hr tape... by then I was more in AF than out.

    Good luck... hopefully you isolate the triggers and it'll go away of its own accord

  • Dr.DanDr.Dan ✭✭✭
    Cheers Corinthian ... I have an appointment with the doc on Friday.
  • I have to say, working in a Cardiology department that if your PSVT is only during some runs they may have trouble picking it up even in a cardiology department... they may give you a 24hr tape and a treadmill test but it may still not be recognised - just to warn you.

     It may be wolff-parkinson-white in which case it should be picked up on an ecg... sounds a bit scary but it exists in something like up to 10% of pop. and is never noticed in many.

     PSVT is more to be triggered when you stress the heart but there may not be a specific trigger.  I really wouldn't be too worried but let us know how you get on.

  • Dr.DanDr.Dan ✭✭✭

    I agree Oops that it will be difficult to catch ... I saw the GP today and am booked in next week for some blood tests and a resting ECG. He said they'd show nothing but would be required before a referal to the cardiology dept. He also agreed that I can continue to run (Leeds HM in 9 days although my sore hamstring may prevent that anyway). I think he was taken aback a bit with a geeky patient arriving with heart rate traces that captured the tachycardia ...

  • When you get referred to the Cardiologist it may well be worth showing them the traces as well... you have no PSVT until you prove you have!

    Normally I would guess they would do a resting ECG, an exercise test and a 24hr recorder which is not so likely to show up anything if you get it that rarely so I would ask about if you can get a cardiac event recorder  (a loop or memo.) You usually keep those 3-4weeks and you can record if you get the PSVT while running... much greater chance of catching it.

  • JJ2JJ2 ✭✭✭
    Dr Dan, that's exactly what I would I have done. It'll it take some time to get investigated but hopefully the final diagnosis will be straightforward.
  • Dr.DanDr.Dan ✭✭✭

    Update ... cut and pasted via a post on the My Last Run thread....

    Leeds Half Marathon. Well, what a strange run... on my target at 8.5 miles for a 1:40 and then got a tachycardia attack. I'm in the process of being diagnosed - almost certainly pSVT. Had a blood test and ECG at the GP's on Friday and will be referred to the cardiologists at the hospital next ... GP said I could run but to be careful if HR goes mad. Only had 4 earlier episodes in 80 runs and so we thought I'd get away with it ... ah well, it was not to be.

    I felt very strong for 8.5 miles, despite all the up hills and was really looking forward to the easier finals stages down Kirkstall Rd. Then my heart rate shot to over 230 (my proper max is 179) which is pretty debilitating so had to stop ... eventually jumped back down to normal after 5 minutes or so ... put in a great couple of miles before another SVT event ... that eventually stopped, so carried on again but was feeling wary ... the final insult was the 3rd attack as I got to the Headrow and was deprived of a decent finish and instead had to jog in.

    I'll take the positives from it  ... felt stong ... no injuries ... great support. But I didn't like having to stop and have folk overtake me (previous attacks have been in training so no problem)... never done that before but had to! It was tough getting all the "keep going mate" comments from well-wishing runners as they passed by.

    1:46:52 in the end - legs felt fine but ego very bruised and feeling sad that I might get robbed of my new-found running life! I like to race and I like to beat my targets ... I don't want to be a recreational jogger - I want to race ... pSVT isn't what I need!

  • tricialitttricialitt ✭✭✭

    Just a thought.......caffeine in gels may also be a culprit- read the ingredients label carefully!

    I get quite a few episodes of SVT, but never when running, usually hangover+ caffeine is the culprit.

  • Hi Dr Dan

    My son is 14 and has a kind of pSVT. he has had episodes of palps since he was 6 years old. They come on out of the blue at rest and can make him grey and clammy. Eventually he has usually vomitted and returned to mormal. His episodes can last up to an hour.

    When he first experienced this i obviously took him to the GP where i think they thought i was just a paranoid mother. Further episodes later, at the age of 8 they finally gave him an Echo and 24hour tape which showed nothing. I should mention that his episodes are usually months apart. He has maybe 2 or 3 a year maximum.

    Each time he has had an episode over the years i jhave tried to get him to the hospital but have never made it in time, he has always reverted before i've gotten him there.

    Fortunately i am now a cardiology nurse and carry a portable ECG machine in my car and managed to record an episode this january. He has been seen by a cardiologist and is now awaiting an 'Ablation' which is sucessful in 90% of cases.

    What i would say is gather as much evidence as you possibly can. write it all down every time it happens because cardiologist can do diddly squat unless they have evidence. Oh andif you hold your nose and blow it's supposed to help revert you. I would also say that there is a difference between'palpitations' and SVT. palps are usually set off by triggers and SVT isn't though it does sound like you have an extreme level of palpitations.

    Good luck sorting it out.

  • Dr.DanDr.Dan ✭✭✭

    triciallet - I don't take gels, so can't blame them.

    Splodge - sounds scary watching a little'un going through that! I tried the "nose blowing" and other technqiues when it happened during the last race but it didn't work for me. RE: Collecting evidence... I have all the dates it's happened on and a few examples captured on my HRM.

    I had another episode a few days after the Leeds HM ... it happened 3 minutes after finishing a very light/easy recovery run. Although still related to running, it's the first time it's happened when I've not actually been running. So, what was "3 events in 80 runs" was followed up by another "3 events in 6 runs"! I've decided to stop running all together until I've been properly checked out.

  • Dr.DanDr.Dan ✭✭✭

    Update:

    Still waiting for my cardioloist appointment but int he meantime I have bee caffeine free. I stopped ruuning for a couple of weeks after the scare above image... but then I started again seeing as my GP had originally sida I could run. All was fine for 3 weeks/50+ miles ... I even broke my 5K PB a week ago. But in yesterday's Leeds 10K, I went tachycardic ... managed to capture it loud and clear on my garmin (my max HR should be 179 bpm).

    http://harpoon.unitedhosting.co.uk/~thin-lizzy.com/SVT_Leeds_10K_small.jpg

  • JJ2JJ2 ✭✭✭
    Very impressive, take it with you to your appointment.They'll still need to do all the tests but it will help.
  • Hi there,

    I think I experienced the same the other day. I too caught it with my Garmin heart rate monitor - see attached screenshot.

    I were running intervals - 400 meters of sprint and 2 minutes of walking. However, during my fifth sprint, my pulse does not increase as expected, and when stopping for the 2 minutes of pause, my heart goes beserk!

    Besides the crazy heart rate (felt like my heart was about to leap out my chest), I didn't observe any other physical abnormalities. I walked around for some two minutes (found a populated place), and then decided to lie down to see if that would make it stop. After some four minutes the rate started decreasing slowly, and when it hit 210 it suddenly jumped back to normal rhythm of 110 bpm, still slowly decreasing as I kept lying there.

    After some time I jogged home at slow pace.

    I had drunk quite the amount of coffee that day - nothing crazy, but 5-7 cups. Somewhat above my normal intake.

    I've been to the doctor's, have had my EKG measured, but am still up for an "echo-cardio-something" in August.

    I've been running (occasionally) since, not experiencing anything. However, I'm not sure whether this is SVT or some other serious VT - what do you think?

    It was the first time I did this kind of interval running, but have done several others. I'm age 31 and normally don't see my heart rate above 190.

    http://nordkamp.dk/puls-amok-2.png

  • Dr.DanDr.Dan ✭✭✭

    Yep, looks and sounds pretty similar to my experience. I'm seeing a cardiologist next week and the week after I'm also having the Echo-cardiogram (an ultrasound to check heart structure etc). I'm  also being fitted with a 24 hour ECG monitor. I intend to go on a long hard run that evening to try to induce a tachycardia so that there's something to report back with (anyone know of a long race on 30th July in Yorkshire ... I can't find one).

  • Yeah - looks quite the same! Although I have this "funny" part during last sprint where the pulse doesn't increase...

    You are brave, going for a "long hard run" the evening before... I've been considering drinking tons of coffee the same day -that seemed to be the trigger the last time image

  • Dr.DanDr.Dan ✭✭✭

    Been a while but thought I'd update this thread in case soemone with SVT is ever looking for info.

    I had the various tests at the end of July 2009 ... an exercise stress test on a treadmill didn't induce anything (I did manage to prove I was in reasonable shape!) ... echocardiogram proved my heart was structurally sound ... the 24 hour ECG monitor was swapped with a 1 week monitor. I managed to catch two events, one just after cycling to work and the other on a 10K trail race (enetred deliberately to try to induce an event).

    I went tachy again in the Leeds Abbey Dash ... seems that 10Ks are doomed, probably the wrong mix of intensity and length.

    Then after some months I eventually I got to see the cardiologists with for the results. SVT was confirmed and various options given (put up with it ... stop running ... take drugs ... get an ablation). I went with the ablation option and was passed on to the chaps who do that (another couple of months of waiting). He checked all the data again ... confirmed SVT again ... and put me on the waiting list.

    This year I've been marathon training - big increase in miles and my base aerobic fitness, aimed at Chester at the end of May. So far in all those 600+ miles I've only had the occasional "spike" rather than a full-blown tachy event. 5K and 10K PBs have come my way too without incident!

    I finally just got the letter telling me I've got to the top of the waiting list ... electrophys investigation and possible ablation (if they find the short-circuit) in early June, about 13 months after first visiting the GP. Timing is handy as it's a week after I do a marathon so will be resting anyway.

    Will report back to this thread to complete the story.

  • Let us know how you get on Dr Dan
  • Dr.DanDr.Dan ✭✭✭

    Well yesterday I had my RF Ablation. Very interesting! And very successful!

    Arrived at 8am, put into a side room, given a gown and told to get changed and "settle in". Filled in some paperwork with a nurse and then the junior member of the two-man team doing the op arrived with the consent form and went through things. At 9ish I was taken downstairs to the "Cath Lab". Onto the table and wired up with a  16-lead ECG while the senior consultant had a brief chat. Local anaesthetic given to the groin region, both sides, and then 5 lines were put in. The first couple hurt a bit (some wincing went on) but the rest were much better ... seemed to take a bit of time for the local to hit the deeper tissues. Then I sat a watched the screens as the 5 probes were fed into my heart. Amazing really.

    They could tell from my ECG that it was very likely that I had an "accessory pathway". They then tried to induce my tachycardia by giving me isoprenaline (an adrenaline mimic) ... they struggled to get my heart rate up very high (doc said I was "too fit") but after they stopped the isoprenaline, I went tachycardic. They were quite excited. It allowed them to confirm everything. They then mapped out the heart, looking for the accessory pathway ... once it was located exactly (they got quite excited again) they fed in the ablation probe and gave a 60 second pulse of radiofrequency. After only 2 seconds, the accessory pathway had been broken. They then waited 20 minutes to make sure it didn't come back ... then I was disconnected and a bit of effort was put in to stopping the bleeding. They give your heparin to prevent any clots forming, so it's actually pretty difficult to stop the bleeds.

    I was taken to the recovery room at about 11:15 and then up to the ward.You have to lie flat and not move for 2 hours. After that you can raise your head but must still keep your legs still for another 2 hours. I did have a bleed on one side during this period ... a bit messy. BY 4pm they said I could move but I stayed put into 5pm. Both docs popped in to see how things were ... then I had my dinner and had to move to another ward (due to some emergency admissions). By this time I could walk around and was very comfortable. I was hooked up to an ECG all the time I was at my bed. Next morning one of the docs popped in to check the groin wounds and I was free to go by 9am ... got the bus home and here I am!

    It was pretty straight-forward and I'm SO glad I had the guts to go through with it. The real test will come when I start running next week ... and racing next month.

    The worst parts were putting in the first few lines and also having to lie still for so long afterwards ... but the reward for that minor discomfort is I'm very likely to be free of SVT ... 1% chance of it coming back.I hope this is useful to anyone going through a  similar experience! 

  • Ouch image

    Glad it went well and that you're on the rapid road to recovery.

    Let us know how the training and racing go.

  • Dr.DanDr.Dan ✭✭✭
     Well, one month on and I have now raced ... the Leeds 10K went off without a hitch, unlike last year where I spent over 10 miuntes at about 240 bpm. I reckon those clever cardiologists have sorted it! image
  • Dr.DanDr.Dan ✭✭✭

    Just to close the loop on this ... post op consultation today and I have been "released". I've run 300+ miles since the op, including several races and lots of hard session ... no issues. image

  • I had the same sort of thing when i was 14/15, it was not only when exersizing  but all the time, my heart rate would go from 65-70 bpm to 200+ for no reason, it made my tired and some times i almost passed out !

     I saw a GP then a cardiologist, then a consultant cardiologist at John Radclife hospital, after weeks of testing they diagnosed it as some sort of tachycardia . I had 1 operation, a day case, and a few days later i was back as nothing was ever wrong !

    Before the op i was almost passing out standing up , now ( a few years later) i can run a 39min 10K and a sub18 5k. 

    Glad to here your ok now !

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