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Paroxysmal supraventricular tachycardia (PSVT)

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Paroxysmal supraventricular tachycardia (PSVT) is episodes of rapid heart rate that start in a part of the heart above the ventricles. "Paroxysmal" means from time to time.

Paroxysmal supraventricular tachycardia (PSVT) MedlinePlus Medical Encyclopedia

Paroxysmal supraventricular tachycardia (PSVT)

Paroxysmal supraventricular tachycardia (PSVT) is episodes of rapid heart rate that start in a part of the heart above the ventricles. "Paroxysmal" means from time to time.

Causes

 
Normally, the chambers of the heart (atria and ventricles) contract in a coordinated manner.
  • The contractions are caused by an electrical signal that begins in an area of the heart called the sinoatrial node (also called the sinus node or SA node).
  • The signal moves through the upper heart chambers (the atria) and tells the atria to contract.
  • After this, the signal moves down in the heart and tells the lower chambers (the ventricles) to contract.
The intrinsic conduction system sets the basic rhythm of the beating heart by generating impulses which stimulate the heart to contract.

The rapid heart rate from PSVT may start with events that occur in areas of the heart above the lower chambers (ventricles).

There are a number of specific causes of PSVT. It can develop when doses of the heart medicine, digitalis, are too high. It can also occur with a condition known as Wolff-Parkinson-White syndrome, which is most often seen in young people and infants.

The following increase your risk for PSVT:

Symptoms

 
Symptoms most often start and stop suddenly. They can last for a few minutes or several hours. Symptoms may include:

Other symptoms that can occur with this condition:

Exams and Tests

 
A physical exam during a PSVT episode will show a rapid heart rate. It may also show forceful pulses in the neck.

The heart rate may be over 100, and even more than 250 beats per minute (bpm). In children, the heart rate tends to be very high. There may be signs of poor blood circulation such as lightheadedness. Between episodes of PSVT, the heart rate is normal (60 to 100 bpm).

An ECG during symptoms shows PSVT. An electrophysiology study (EPS) may be needed for an accurate diagnosis and to find the best treatment.

Because PSVT comes and goes, to diagnose it people may need to wear a 24-hour Holter monitor. For longer periods of time, another tape of the rhythm recording device may be used.

During a heart Holter monitor study, the patient wears a monitor that records electrical activity of their heart (similarly to the recording of an electrocardiogram). This usually occurs for 24 hours, while at the same time the patient also records a diary of their activity. Health care providers then analyze the recording, tabulate a report of the heartís activity, and correlate irregular heart activity with the entries of the patientís diary.

Treatment

 
PSVT that occurs only once in a while may not need treatment if you don't have symptoms or other heart problems.

You can try the following techniques to interrupt a fast heartbeat during an episode of PSVT:

  • Valsalva maneuver. To do this, you hold your breath and strain, as if you were trying to have a bowel movement.
  • Coughing while sitting with your upper body bent forward.
  • Splashing ice water on your face

You should avoid smoking, caffeine, alcohol, and illicit drugs.

Emergency treatment to slow the heartbeat back to normal may include:

  • Electrical cardioversion, the use of electric shock
  • Medicines through a vein

Long-term treatment for people who have repeat episodes of PSVT, or who also have heart disease, may include:

  • Cardiac ablation, a procedure used to destroy small areas in your heart that may be causing the rapid heartbeat (currently the treatment of choice for most PSVTs)
  • Daily medicines to prevent repeat episodes
  • Pacemakers to override the fast heartbeat (on occasion may be used in children with PSVT who have not responded to any other treatment)
  • Surgery to change the pathways in the heart that send electrical signals (this may be recommended in some cases for people who need other heart surgery)

Outlook (Prognosis)

 
PSVT is generally not life threatening. If other heart disorders are present, it can lead to congestive heart failure or angina.

When to Contact a Medical Professional

 
Call your health care provider if:
  • You have a sensation that your heart is beating quickly and the symptoms do not end on their own in a few minutes.
  • You have a history of PSVT and an episode does not go away with the Valsalva maneuver or by coughing.
  • You have other symptoms with the rapid heart rate.
  • Symptoms return often.
  • New symptoms develop.

It is especially important to call if you also have other heart problems.

Alternative Names

 
PSVT; Supraventricular tachycardia; Abnormal heart rhythm - PSVT; Arrhythmia - PSVT; Rapid heart rate - PSVT; Fast heart rate - PSVT

References

 
Olgin JE, Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 37.

Van Hare GF. Disturbances of rate and rhythm of the heart. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 435.

Zimetbaum P. Cardiac arrhythmias with supraventricular origin. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 64.

Review Date 2/24/2016

 
Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

 

Paroxysmal supraventricular tachycardia - Wikipedia, the free encyclopedia

Paroxysmal supraventricular tachycardia (PSVT) is a type of supraventricular tachycardia.[2] Often people have no symptoms.[1] Otherwise symptoms may include palpitations, feeling lightheaded, sweating, shortness of breath, and chest pain.[3] Episodes start and end suddenly.[4]

The cause is not known. Risk factors include alcohol, caffeine, nicotine, psychological stress, and Wolff-Parkinson-White syndrome which often is inherited from a person's parents. The underlying mechanism typically involves an accessory pathway that results in re-entry. Diagnosis is typically by an electrocardiogram (ECG) which shows narrow QRS complexes and a fast heart rhythm typically between 150 and 240 beats per minute.[4]

Vagal maneuvers, such as the valsalva maneuver, are often used as the initial treatment. If not effective and the person has a normal blood pressure the medication adenosine may be tried. If adenosine is not effective a calcium channel blockers or beta blocker maybe used. Otherwise synchronized cardioversion is the treatment.[5] Future episodes can be prevented by catheter ablation.[4]

About 2.3 per 1000 people have paroxysmal supraventricular tachycardia.[6] Problems typically begin in those 12 to 45 years old.[4][6] Women are more often affected than men. Outcomes in those who otherwise have a normal heart are generally good.[4]

An ultrasound of the heart may be done to rule out underlying heart problems.[1]

 

Causes

 

Normally, the chambers of the heart (atria and ventricles) contract in a coordinated manner.

The intrinsic conduction system sets the basic rhythm of the beating heart by generating impulses which stimulate the heart to contract.

The rapid heart rate from PSVT may start with events that occur in areas of the heart above the lower chambers (ventricles).

There are a number of specific causes of PSVT. It can develop when doses of the heart medicine, digitalis, are too high. It can also occur with a condition known as Wolff-Parkinson-White syndrome, which is most often seen in young people and infants.

The following increase your risk for PSVT:

Symptoms

 

Symptoms most often start and stop suddenly. They can last for a few minutes or several hours. Symptoms may include:

Other symptoms that can occur with this condition:

Exams and Tests

A physical exam during a PSVT episode will show a rapid heart rate. It may also show forceful pulses in the neck.

The heart rate may be over 100, and even more than 250 beats per minute (bpm). In children, the heart rate tends to be very high. There may be signs of poor blood circulation such as lightheadedness. Between episodes of PSVT, the heart rate is normal (60 to 100 bpm).

An ECG during symptoms shows PSVT. An electrophysiology study (EPS) may be needed for an accurate diagnosis and to find the best treatment.

Because PSVT comes and goes, to diagnose it people may need to wear a 24-hour Holter monitor. For longer periods of time, another tape of the rhythm recording device may be used.

During a heart Holter monitor study, the patient wears a monitor that records electrical activity of their heart (similarly to the recording of an electrocardiogram). This usually occurs for 24 hours, while at the same time the patient also records a diary of their activity. Health care providers then analyze the recording, tabulate a report of the heartís activity, and correlate irregular heart activity with the entries of the patientís diary.

Treatment

PSVT that occurs only once in a while may not need treatment if you don't have symptoms or other heart problems.

You can try the following techniques to interrupt a fast heartbeat during an episode of PSVT:

You should avoid smoking, caffeine, alcohol, and illicit drugs.

Emergency treatment to slow the heartbeat back to normal may include:

Long-term treatment for people who have repeat episodes of PSVT, or who also have heart disease, may include:

Outlook (Prognosis)

 

PSVT is generally not life threatening. If other heart disorders are present, it can lead to congestive heart failure or angina.

When to Contact a Medical Professional

 

Call your health care provider if:

It is especially important to call if you also have other heart problems.

Alternative Names

PSVT; Supraventricular tachycardia; Abnormal heart rhythm - PSVT; Arrhythmia - PSVT; Rapid heart rate - PSVT; Fast heart rate - PSVT

Images

References

 

Olgin JE, Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 37.

Van Hare GF. Disturbances of rate and rhythm of the heart. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 435.

Zimetbaum P. Cardiac arrhythmias with supraventricular origin. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 64.

Read More

Review Date 2/24/2016

Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

Supraventricular tachycardia - Wikipedia, the free encyclopedia



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