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Paroxysmal supraventricular tachycardia (PSVT) is a sudden and unexpected rapid heart rate that starts and stops without warning. A normal heart rate is between 60 to 100 beats per minute (bpm), but an episode of PSVT may increase the heart rate to over 250 bpm.
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“Do You Know the Feeling?”: A PSVT Educational Poster
Heart Beat Cheat Sheet
Guide to Starting a Conversation with Your Doctor
Making Sense of Clinical Trials Brochure
Social Media Graphics and Sample Posts
Download Your Free Outsmart PSVT Toolkit
Enter your email to unlock a downloadable and free toolkit with helpful information on how to outsmart PSVT.
By submitting your email, you confirm you are over 18 years of age and consent to receive future emails from OutsmartPSVT.com and Milestone Pharmaceuticals. View the Terms of Use and Privacy Policy
“Do You Know the Feeling?”: A PSVT Educational Poster
Heart Beat Cheat Sheet
Guide to Starting a Conversation with Your Doctor
Making Sense of Clinical Trials Brochure
Social Media Graphics and Sample Posts
PSVT Symptoms
- Rapid pulse
- Chest pressure or pain
- Shortness of breath
- Anxiety
- Lightheadedness or dizziness
- Fainting
- Sudden onset of fatigue
PAROXYSMAL
A sudden occurrence of medical symptoms, generally short and frequent in duration
SUPRAVENTRICULAR
An abnormal heart rhythm that originates in the atria (upper chambers) of the heart, above the ventricles (lower chambers)19
TACHYCARDIA
A fast heart rate of more than 100 beats per minute in adults20
PSVT Symptoms
- Rapid pulse
- Chest pressure or pain
- Shortness of breath
- Anxiety
- Lightheadedness or dizziness
- Fainting
- Sudden onset of fatigue
While PSVT is not typically life-threatening, symptoms may be alarming because of the unexpectedness of episodes combined with the rapid heart rate. Consequently, PSVT may limit the ability to participate in certain activities such as driving or travel. Some people experience significant anxiety and fear of the next episode. The episodes themselves may be debilitating and exhausting, leading some to avoid certain activities or withdraw from their normal routines.
Receiving a diagnosis of PSVT can be overwhelming. It is important to recognize there are a range of treatment options, resources, and information to help you actively manage your PSVT, starting with this website. You’ve come to the right place to find practical tips throughout your PSVT journey.
FREQUENTLY ASKED QUESTIONS
Browse our frequently asked questions (FAQs) to clear the confusion surrounding PSVT, an often overlooked and misdiagnosed heart condition.
To diagnose PSVT, your doctor needs to see your heartbeat during an episode of PSVT. However, since PSVT happens suddenly and unexpectedly, this can make it difficult to catch an episode as it is occurring.
If you visit the emergency department while an episode is still occurring, your heartbeat will be recorded with an electrocardiogram (ECG or EKG). If your episode has already stopped by the time you reach the emergency department or when the electrocardiogram is done, when you leave the emergency department you may be given a device that records heart rate over time, such as a Holter monitor (worn 24 to 48 hours) or an event monitor (worn for one to two months). If the heartbeat during future episodes can’t be recorded with one of these devices, your doctor may recommend a tiny monitor that is inserted under skin (usually done in the office through a small needle) and that can monitor your heartbeat for up to several years or until a diagnosis is made. Your doctor will work with you to understand which option is right for you.
The goal of treatment in PSVT is to interrupt the “short circuit” to stop the episode and bring the heart rate back to normal. Treatment options to stop an episode of PSVT after it has started include:
- Vagal maneuvers such as pressing on one of the carotid arteries (the large vessels that bring blood from the heart to the brain).
- Injections such as adenosine or verapamil. These are administered in an ambulance or in an emergency department through an intravenous (IV) line.
- Single dose of medication taken by mouth that acts on the heart’s short circuit may be prescribed to stop an episode.
- Cardioversion where an electrical current is sent to the heart through patches placed on the chest while the patient is sedated with anesthesia. The electrical current stops PSVT by resetting the heart rhythm back to normal.
Patients with frequent episodes of PSVT may be prescribed medication that they take daily to prevent PSVT recurrences. Each of these medications act on the heart’s electrical system to make it harder for PSVT to start. These medications fall into one of several categories:
- Beta blockers are approved for the treatment of high blood pressure, angina, and after a heart attack. An example is metoprolol.
- Calcium channel blockers are approved for the treatment of high blood pressure and angina. Examples are diltiazem and verapamil.
- Antiarrhythmic drugs were developed to act specifically on the heart’s electrical system and therefore have little to no effect on blood pressure. Examples are propafenone, flecainide, and amiodarone.
Even though some of these medications were not specifically created to treat PSVT, they do work for this condition and appear as options in PSVT treatment guidelines from heart rhythm experts. Each of the drugs has its own unique possible side effects, making it important to discuss these options with your doctor.
Catheter ablation and open-heart surgery may potentially cure PSVT by directly burning or cutting the short circuit that is the cause of the abnormal rhythm. As catheter ablation therapy has advanced, open-heart surgery is less common for this purpose.
Catheter ablation is performed in a special room in a hospital with X-ray and other specialized equipment. After receiving medication to help you relax, your doctor inserts a flexible wire with a metal tip into an artery or vein in your leg and then threads it into your heart while watching it under X-ray. After moving the wire directly over the abnormal tissue, the tip is either heated or cooled to an extreme temperature, which destroys the short circuit. In most people, catheter ablation will cure the problem to eliminate future PSVT episodes. In some people, episodes may return even after a catheter ablation. Although the procedure is generally very safe, as with any invasive procedure there are potential complications.
Discuss with your doctor what treatment is right for you.
More research is needed about who is most likely to experience PSVT. A 1998 research study found that women have twice the risk of men of developing PSVT. In addition, those older than 65 years of age have five times the risk of younger persons of developing PSVT.
PSVT episodes can begin at any stage of life. Because the extra pieces of electrical tissue or “short circuits” are something people with PSVT are born with, episodes can occur even in otherwise very healthy individuals. Episodes may last anywhere from minutes to hours. How often episodes happen, and the intensity of symptoms, will vary from person to person.
Episode frequency varies from person to person. For some, episodes may occur daily, while for others, they may occur a few times a year or less. In addition–and for reasons that aren’t really understood–an individual’s episode frequency can change. Where PSVT episodes may have occurred only once or twice a year for many years, they can suddenly come much closer together, even as often as several times per week. If you notice a sudden or dramatic change in either how often your episodes occur or how long they last, you should let your doctor know so you can discuss whether a different treatment plan might be right for you.
Your heart beats, or contracts, each time it receives an electrical signal from specialized electrical tissue called the sinus node, or sinoatrial node (SA node). The SA node is within the heart’s top chambers (right atrium (RA) and left atrium (LA)). The electrical signal runs from the top down to the bottom chambers (right ventricle (RV) and left ventricle (LV)) over a structure called the atrioventricular node (AV node). Once the signal reaches the ventricles, the signal stops and no more beating occurs until the SA node sends out a new signal. In a normal heart, the AV node is the only way for the electrical impulse to travel from the atria down to the ventricles and that impulse does not have a way to get from the ventricles back up to the atria.
With PSVT, there is an extra piece of electrical tissue that allows the electrical current to travel very rapidly in a circle. If that extra tissue forms within the AV node, the current can now travel down one part of the AV node and up the other in a small circle, sending impulses out to both the atria and ventricles along the way. This is the situation in the most common form of PSVT, called AV nodal reentrant tachycardia, or AVNRT.
In the next most common form of PSVT, called atrioventricular reciprocating tachycardia (or AVRT), there is an extra piece of electrical tissue that directly connects the atria and the ventricles. In AVRT, the electrical current starts off like in a normal heart beat by traveling from the atria to the ventricles over the AV node. However, in AVRT, the extra piece of electrical tissue allows the current to travel back up to the atria, creating a “short circuit.” Once it gets back to the atria, it goes back down the AV node and the cycle continues over and over, resulting in a rapid heart rate. AVRT is sometimes referred to as Wolff-Parkinson-White syndrome, or WPW. Although both AVRT and WPW are caused by the same type of abnormal electrical connections, they are two different conditions.
PSVT refers to any abnormal rhythm that starts above the lower chambers, or ventricles. This definition includes many different arrhythmias. When cardiologists and electrophysiologists discuss PSVT, they are referring specifically to atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). Explore the National Heart, Lung and Blood Institute website for a complete overview on the different types of arrhythmias, including SVT and PSVT.
GLOSSARY
Part of being able to outsmart PSVT requires knowing the lingo. Below you’ll find definitions for words you may commonly hear about this condition.
Arrhythmia
Bearing down
Cardioversion
Catheter ablation
Electrocardiogram (EKG or ECG)
Holter monitor
Vagal maneuvers
Further Resources
There are groups and organizations dedicated to supporting and educating people with heart conditions and arrhythmias like PSVT. Follow the links below to find out more.
REFERENCES
1Colucci, R.A. Am Fam Physician. 2010;82(8), 942-952.
2Wood, K.A. Eur J Cardiovasc Nurs. 2007;6(4):293-302.
3John Hopkins Medicine Health Library. Paroxysmal Supraventricular Tachycardia (PSVT).
4Al-Zaiti, S.S. Crit Care Nurs Clin North Am. 2016;28(3): 309-316.
5National Heart, Lung, and Blood Institute. Catheter Ablation: Overview.
8Milestone Pharmaceuticals data on file: Primary research interviews conducted by The Planning Shop International, 2014, N=49 patients; Milestone Pharmaceuticals data on file: Primary research interviews conducted by Triangle Insights Group, May/June 2017, N=44 physicians, 20 patients, and 14 payers.
9Mayo Clinic. Supraventricular Tachycardia. 2018.
10Merriam-Webster Medical Dictionary. Arrhythmia. 2018.
11ACLS Certification Institute. Vagal Maneuvers. 2014.
12American Heart Association. Cardioversion. 2016.
13John Hopkins Medicine Health Library. Paroxysmal Supraventricular Tachycardia (PSVT).