Heart Rhythm Disorders: Supraventricular Tachycardia Treatment

  • Treatment

    If your heart rate is very fast and doesn't slow within a few minutes, and you have other signs and symptoms of heart distresssuch as dizziness or shortness of breath, you may need chemical or electrical "cardioversion." This can restore normal heart rhythm. Signs and symptoms of heart distress include low blood pressure, fluid in the lungs, chest pain, shortness of breath, decreased level of consciousness, and shock.

    Chemical cardioversion uses medication (usually intravenous) to restore a normal heart rhythm.

    Electrical cardioversion restores normal heart rhythm by delivering volts of energy to "shock" the heart. When used in urgent situations, the main goal is to restore the ventricle rate to normal. It involves placing conducting paddles on your chest to deliver volts of energy that "shock" the heart into a normal rhythm. The emergency department doctor may use an intravenous antiarrhythmic medication before cardioversion. This may help to make the procedure more successful, and maintain normal heart rhythm after it is restored.

    Because the severity of symptoms determines therapy for SVT, self-care can often play a key role. Sometimes, vagal maneuvers are the only treatment necessary. Vagal maneuvers are actions that affect the nerve that extends from the brain through the neck and chest to many organs (the vagus nerve). Among its many functions, the vagus nerve releases a chemical that slows the heart rate. Vagal maneuvers that can be done on your own include placing a rubber glove or water bottle glove filled with ice and water on the face for a few minutes, splashing the face with cold water or placing a towel soaked with ice water on the face, and the Valsalva maneuver (holding the nostrils closed while trying to breathe out forcefully). If arrhythmia only occurs from time to time and you do not faint, your doctor may recommend vagal maneuvers.

    Avoid stimulants and other medications that might aggravate your condition and cause arrhythmia. At times, an increased heart rate might be associated with the use of certain substances such as caffeine, nicotine, tobacco, or street drugs (cocaine, amphetamines). Even alcohol and over-the-counter drugs, such as decongestants and diet pills, can worsen or cause arrhythmia. If you suspect that any of these factors play a role in your condition, it is important to modify your lifestyle and habits.

    Take steps to reduce emotional and general life stressors. Emotional stress and anxiety can raise the level of stress hormones that are released into the bloodstream by the nervous system to prepare the body for action. Release of these hormones can speed heart rate and interfere with heart rhythm and pumping strength. Deep-breathing exercises, yoga, biofeedback, and meditation can help you to gain control over your stress and slow your heart rate in a natural way. In some cases, these steps may be the only treatment necessary.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Radiofrequency catheter ablation is effective for people who do not want to take medications, cannot tolerate the side effects of drugs, or whose symptoms are not relieved by drug therapy. Radiofrequency catheter ablation is an effective alternative to long-term drug therapy. It is often used in people who cannot tolerate long-term drug use, or whose symptoms do not respond to the medication. Some people choose the procedure if they do not wish to take drugs throughout their lives.

    In radiofrequency catheter ablation, a doctor inserts large IV catheters into the vein or artery in the groin and inserts a very thin, flexible electrical probe (catheter). Using an x-ray, he or she guides the catheter through the blood vessel to the area of the heart where chaotic, disorganized electrical signals are being released. A radiofrequency current is then transmitted to this site, producing a small amount of heat. The heat kills the cells that are producing the extra electrical impulses. It may take several attempts to stop the arrhythmia, depending on where the impulses are being produced and the type of SVT.

    This technique is successful in over 90% of people with SVT. However, like all procedures, it carries some risk, including bleeding, infection, damage to the heart or blood vessels, or damage to the normal conduction system of the heart necessitating pacemaker implantation. Your doctor will discuss these risks if you are considering an ablation procedure.

    Electrical cardioversion is often used for distressing symptoms of atrial flutter or atrial fibrillation. It is used to restore normal heart rhythm. Electrical cardioversion is usually reserved for people who do not respond to drugs. Some people choose electrical cardioversion over drug therapy, especially since antiarrhythmic medications can actually cause arrhythmia in people with existing heart disease.

    Electrical cardioversion restores the normal heart rhythm with electricity. It involves placing conducting paddles on your chest and delivering volts of energy that shock the heart into a normal rhythm. It requires a short-acting anesthesia (meaning that you’ll be asleep). You will be monitored during the procedure so that the doctor can make certain that your heart rate is within a safe range, and that your blood pressure remains normal. The level of oxygen in your blood is also checked. Recovery can take several hours. During this time, your doctor will conduct an electrocardiogram to monitor your heart rhythm and assess the results.

    Stress reduction techniques such as yoga, meditation, or biofeedback may be helpful for some people in reducing symptoms and slowing the heart rate. Anxiety can raise the level of hormones released into the bloodstream that prepare the body for action. These hormones can interfere with normal heart rhythm and pumping strength. Relaxation techniques that focus on deep breathing and concentration—such as yoga and meditation—can slow the heart rate and reduce other symptoms as well as improve your ability to cope with stressful events before symptoms start. Biofeedback is a technique that is used to "open communication" between you and your body. Although the nervous system normally controls the seemingly automatic responses produced by your body, biofeedback teaches you to manage this process through relaxation and concentration.

    Increases in heart rate and related symptoms are common during normal pregnancy, and rarely create problems for the mother or the fetus. Such symptoms as palpitations, shortness of breath and fatigue with normal activity, and lightheadedness are a natural part of pregnancy. They result from physical changes and shifts in hormone balance. However, they can easily be mistaken for more serious heart rhythm problems. When heart rhythm problems do occur, they rarely pose any serious threat to the mother or fetus.

    If you are pregnant and experience any of these symptoms, your doctor will want to conduct a complete physical to rule out possible heart-related and non-heart-related causes. Such factors as thyroid disease, caffeine intake, and emotional stress can contribute to arrhythmia.

    Sinus tachycardia is one of the most common types of SVT found during pregnancy. Avoiding stimulants such as caffeine or decongestants will help control the symptoms.

    Women with pre-existing heart defects, such as mitral valve and aortic valve disease, are at a higher risk for complications during pregnancy. If your condition becomes serious and vagal maneuvers don’t stop the arrhythmia, your doctor may try intravenous adenosine, verapamil, or procainamide. These drugs can cause the fetal heart rate to slow and require close monitoring and follow-up. If symptoms continue despite these measures, electrical cardioversion may be tried.

    Most people can lead normal and comfortable lives despite being diagnosed with SVT. The prognosis for SVT is excellent, particularly if you have a healthy heart. In general, SVT is tolerable and rarely life-threatening. Avoiding triggers, such as stress, certain physical activities, and stimulants, can help to decrease the likelihood of future episodes. Drug therapy is often effective for stopping arrhythmias that do not respond to lifestyle modification and vagal maneuvers. Fortunately, radiofrequency catheter ablation can "cure" most arrhythmias that become especially troublesome.

    The number and type of follow-up visits to your doctor that are necessary after SVT is diagnosed depend on how troublesome your symptoms are and the type of treatment, if any, you’re receiving. In uncomplicated cases, self-care (including lifestyle modification and vagal maneuvers) is often the only treatment needed for SVT. For these cases, your doctor may only ask you to contact him or her if the symptoms change or worsen.

    If you are taking medication on a long-term basis, your doctor may want to see you more regularly to make sure that your symptoms are effectively controlled, and to ensure that you are able to tolerate any side effects. How often you need to be seen depends on different factors, such as your age, any type of existing heart disease or other risk factors, and the medication you’re taking.

    Keep in mind that if you have any symptoms, such as severe chest pain, sudden shortness of breath, return of heart palpitations, fainting, or dizziness, you should contact your doctor immediately.

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