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Supraventricular Tachycardia

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Overview

Supraventricular tachycardia (SVT) is a prevalent cardiac rhythm problem in which the heart beats much more rapidly than usual.

The term is derived from Latin &ndash; supraventricular meaning &quot;above the ventricles&quot; and tachycardia meaning &quot;rapid heart rate.&quot; 
&nbsp;

A typical resting heart rate ranges between 60 and 100 beats per minute (bpm). A heart rate above 100 bpm is known as tachycardia. In the case of SVT, the heart rate ranges from 150 to 220 bpm<a href="#accordion">[6]</a>.

In babies and children, SVT is the most widespread symptomatic dysrhythmia. While children with congenital heart disease are more likely to develop SVT, the most common cause of SVT in kids younger than 12 years is an extra atrioventricular pathway leading to atrioventricular reentry tachycardia (AVRT)<a href="#accordion">[5]</a>. 
&nbsp;

Moreover, medicine, caffeine, alcohol, physical or emotional <a href="https://merisehat.pk/disease/stress">stress</a>, or smoking cigarettes can all trigger SVT in patients predisposed to the condition.

An episode can take place while the person is exercising or even while they&rsquo;re lying in bed. Even though a fast heartbeat can be frightening, it usually does not lead to major issues. Nevertheless, it is best to consult a doctor about it. 
&nbsp;

This condition is classified into: 
&nbsp;

<ul>
	<li>
	<h5>Atrioventricular Nodal Reentrant Tachycardia</h5>
	</li>
</ul>

The most prevalent type of supraventricular tachycardia is atrioventricular nodal reentrant tachycardia. It is the most common non-sinus tachydysrhythmia, with a prevalence of 35 per 10,000 person-years or 2.29 per 1000 people<a href="#accordion">[5]</a>.

The heart has an additional pathway (reentrant circuit) near the AV node &ndash; the electrical signal circles around rather than moving down to the ventricles. Consequently, the person experiences a rapid heartbeat. 
&nbsp;

<ul>
	<li>
	<h5>Atrioventricular Reciprocating Tachycardia</h5>
	</li>
</ul>

Atrioventricular reciprocating tachycardia is the second most frequent form of supraventricular tachycardia. It is most typically detected in adolescents and people who have <a href="https://merisehat.pk/disease/wolff-parkinson-white-syndrome">Wolff-Parkinson-White syndrome</a>.

An unusual pathway connects the atria and ventricles, causing the electric signals to circle continuously, i.e., to travel more quickly in the circuit than they would without the extra link. 
&nbsp;

<ul>
	<li>
	<h5>Atrial Tachycardia</h5>
	</li>
</ul>

Atrial tachycardia is more likely to affect individuals with heart conditions. It occurs when a short circuit in the right or left atrium causes a defective electrical impulse. The electric impulses come from somewhere other than the SA node and induce the atria to beat more quickly. It can last anywhere between a few seconds to several hours. 
&nbsp;

<ul>
	<li>
	<h5>Paroxysmal SVT (PSVT)</h5>
	</li>
</ul>

When SVT occurs only occasionally, it is called paroxysmal supraventricular tachycardia. The instances are brief. Females are twice as likely to develop paroxysmal SVT than males, and older people are five times more likely to develop it than younger people<a href="#accordion">[5]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Other Types Of SVT</h5>
	</li>
</ul>

Supraventricular tachycardia can also manifest as:

<ol>
	<li>Nonparoxysmal junctional tachycardia (NPJT)</li>
	<li>Sinus tachycardia</li>
	<li>Inappropriate sinus tachycardia (IST)</li>
	<li>Multifocal atrial tachycardia (MAT)</li>
	<li>Sinus nodal reentrant tachycardia (SNRT)</li>
	<li>Junctional ectopic tachycardia (JET) 
	&nbsp;</li>
</ol>

Signs and Symptoms

A very rapid heartbeat, i.e., 100 bpm or more at rest, is the primary symptom of supraventricular tachycardia. The quick bursts come and go abruptly, with periods of normal heart rate between them. It can last anywhere from several seconds to a few hours. 
&nbsp;

<ul>
	<li>
	<h5>In Adults</h5>
	</li>
</ul>

When the heart beats too fast, it does not have enough time to refill with blood completely between beats. That means it is unable to send sufficient blood to the body, which causes the following symptoms:

<ol>
	<li>Irregular heartbeats</li>
	<li>Pounding in the neck</li>
	<li>Weakness or extreme fatigue</li>
	<li>Exercise intolerance</li>
	<li>Chest pain</li>
	<li>Difficulty breathing</li>
	<li>Feeling lightheaded or dizzy</li>
	<li>Sweating</li>
	<li>Fainting or near-fainting (syncope) 
	&nbsp;</li>
</ol>

According to a 2013 study, panic attacks and anxiety are widespread among SVT patients<a href="#accordion">[3]</a>. A severe episode may lead to unconsciousness or cardiac arrest. 
&nbsp;

<ul>
	<li>
	<h5>In Infants And Young Children</h5>
	</li>
</ul>

The signs and symptoms of SVT can be challenging to recognize in babies and young kids. It usually presents as follows:

<ul>
	<li>Sweating</li>
	<li>Inadequate feeding</li>
	<li>Pale skin tone</li>
	<li>Fast pulse 
	&nbsp;</li>
</ul>

Important!

<ul>
	<li>Consult a pediatrician immediately if a child exhibits one or more symptoms.</li>
	<li>Contact a doctor if you or a loved one is experiencing a rapid heartbeat for the first time or if an abnormal heart rhythm lasts more than a few seconds. 
	&nbsp;</li>
</ul>

Causes

Some people are born with irregular heart pathways or electrical circuits, while some experience SVT due to abnormal electrolytes or thyroid function. Others still develop a defective circuit due to scar tissue from surgery.

A few individuals associate an SVT episode with a clear trigger, like a workout, stress, or sleep deprivation. 
&nbsp;

The following factors may contribute to an SVT episode:

<ol>
	<li>Cardiovascular disease</li>
	<li>Heart failure</li>
	<li>Wolff-Parkinson-White syndrome</li>
	<li>Chronic obstructive pulmonary disease</li>
	<li>Alcohol consumption</li>
	<li>Drug abuse</li>
	<li>Pregnancy</li>
	<li>Chronic lung disease</li>
	<li>Excessive caffeine consumption</li>
	<li>Stress or exhaustion</li>
	<li>Smoking</li>
	<li>Thyroid disease</li>
	<li>Specific medicines, including decongestants, asthma medications, and cold and allergy medications<a href="#accordion">[6]</a>. 
	&nbsp;</li>
</ol>

Most of the patients will present with symptoms like palpitations, lightheadedness, anxiety, dyspnea, chest discomfort, syncope, or even with shock or signs of heart failure. However, some patients may be asymptomatic. The condition is discovered during routine health screening when the onset can be triggered by stress secondary to emotional stress or physical activity. 
&nbsp;

Diagnosis

The doctor examines and gathers information about the patient&rsquo;s symptoms and previous medical history. Questions usually include:

<ul>
	<li>How old were you when you became aware of the issue</li>
	<li>What were you doing when you first experienced the symptoms; for instance, whether you were exercising or under undue stress at that moment</li>
</ul>

<ul>
	<li>Did the symptoms appear unexpectedly or gradually</li>
	<li>How long do the symptoms typically last</li>
</ul>

<ul>
	<li>Do you or a family member have any heart-related issues or surgeries 
	&nbsp;</li>
</ul>

Blood tests are typically performed to rule out conditions that trigger comparable symptoms, like sinus tachycardia, junctional tachycardia, atrial fibrillation, multi-atrial tachycardia, atrial tachycardia, and atrial flutter. 
&nbsp;

<ul>
	<li>
	ECG
	</li>
</ul>

The first step in assessing SVT is to get an ECG. This test tracks the electrical activity of the heart. It records the length and time of each electrical phase of the heartbeat and indicates how quickly or slowly the heart beats. 
&nbsp;

<ul>
	<li>
	Holter Monitor
	</li>
</ul>

The Holter monitor is a comparatively tiny, battery-powered EKG that tracks the activity of the heart for approximately 24-48 hours. It is worn to monitor the heart&#39;s activity during everyday tasks. 
&nbsp;

<ul>
	<li>
	An Event Recorder
	</li>
</ul>

This wearable ECG device detects unusual arrhythmias. When symptoms appear, the patient clicks a button, and the monitor collects that information. An event recorder can be worn for a maximum of 30 days. 
&nbsp;

<ul>
	<li>
	Echocardiogram
	</li>
</ul>

An echocardiogram uses sound waves to reveal information about the heart and its valves. 
&nbsp;

<ul>
	<li>
	Implantable Loop Recorder
	</li>
</ul>

This recorder is implanted in the chest to sense abnormal heart rhythms. 
&nbsp;

<h5>Additional Tests</h5>

If a patient is diagnosed with supraventricular tachycardia, the doctor may order additional tests to determine the type and cause of the condition. These include: 
&nbsp;

<ul>
	<li>Electrophysiological Study</li>
</ul>

A blood vessel directs one or more narrow catheters, usually from the groin, to the heart. Sensors at the catheter tips track the electrical activity of the heart. 
&nbsp;

<ul>
	<li>Exercise Stress Test</li>
</ul>

Stress or workout can cause or aggravate SVT. A stress test generally involves exercising on a treadmill or fixed bicycle while the heart rate is closely monitored. If the patient cannot exercise, they may be given a drug during the test to induce the heart in a manner comparable to exercise. 
&nbsp;

<ul>
	<li>Tilt Table Test</li>
</ul>

The doctor may suggest this test if the patient has had fainting episodes. The patient is asked to lay straight on a table and relax while their heart rate and blood pressure are checked. The table is then tilted so the doctor can observe how the heart reacts to the change. 
&nbsp;

Treatment

Mild instances of SVT can be managed with lifestyle changes and home remedies. However, lengthy or recurring episodes necessitate extra care and treatment. 
&nbsp;

<h5>Lifestyle Changes And Home Remedies</h5>

<ul>
	<li>Vagal Maneuvers</li>
</ul>

Vagal maneuvers such as the following stimulate the vagus nerve to help control the heart rate:

<ul>
	<li>Take a deep breath and hold it by closing the throat. Then, push with the belly as if straining for a bowel movement for about 15 seconds. Exhale. This will cause a fluctuation in the blood pressure, eventually enabling the heart rate to return to normal. This is called the Valsalva maneuver.</li>
	<li>Ice water face dip can also help regulate the heart rate.</li>
	<li>The patient is asked to lie down straight and stretch their neck while exerting pressure for about 10 seconds on the neck where the carotid sinus splits. This is called a carotid sinus massage. It enables the body to release chemicals that decrease the heart rate. 
	However, carotid massage is not recommended for patients who have carotid bruit or have had a transient ischemic attack or cerebral vascular accident within the last three months. It is also not suggested for kids or babies. Don&#39;t try to massage your carotid sinuses on your own. 
	&nbsp;</li>
</ul>

Note: DO NOT attempt these on your own. Always consult a doctor first regarding any medical condition and its long-term management. 
&nbsp;

<ul>
	<li>Eat A Heart-Healthy Diet</li>
</ul>

Eat meals that include a generous portion of fruits, whole grains, and vegetables. Reducing the consumption of salt and saturated fats can help control cholesterol and hypertension. 
&nbsp;

<ul>
	<li>Exercise Daily</li>
</ul>

Exercise every day. Being physically active helps build a good cardiovascular reserve. 
&nbsp;

<ul>
	<li>Quit Smoking And Alcohol</li>
</ul>

If the patient is finding it difficult to quit smoking and/or drinking, they can join a program that can assist them to deal with their addiction. 
&nbsp;

<ul>
	<li>Maintain A Healthy Weight</li>
</ul>

Obesity increases the likelihood of heart disease. The doctor will be able to guide properly about maintaining the optimal weight with respect to the patient&rsquo;s BMI. 
&nbsp;

<ul>
	<li>Maintaining Follow-up Care</li>
</ul>

It&rsquo;s important to take medicines exactly as directed by the doctor. Also, routine health screenings are part of a healthy lifestyle.

Note: Before attempting any of these remedies, please consult a physician to ensure they are appropriate in your case. Inform the doctor if your symptoms aggravate. 
&nbsp;

<ul>
	<li>Cardioversion</li>
</ul>

Paddles or patches on the chest are used to give an electric shock to the heart to help reset the heart rhythm. Cardioversion is generally used when vagal maneuvers and medicines fail. 
&nbsp;

<ul>
	<li>Catheter Ablation</li>
</ul>

Ablation is safe and beneficial for individuals with frequent supraventricular tachycardia, including kids. An electrophysiologist inserts narrow, flexible tubes called catheters via veins or arteries, generally in the groin. Sensors on the catheter&#39;s tip use heat or cold energy to prevent irregular electrical impulses and restore a normal heartbeat. 
&nbsp;

<ul>
	<li>Pacemaker</li>
</ul>

In rare cases, a tiny, implantable device known as a pacemaker is implanted close to the collarbone to stimulate the heart to beat. 
&nbsp;

<ul>
	<li>Medicine</li>
</ul>

Medicines can help slow down the heart rate if the tachycardia occurs frequently or if the episodes are prolonged. 
&nbsp;

<ul>
	<li>Adenosine</li>
</ul>

Adenosine is the first-line treatment to be used if vagal maneuvers are unsuccessful. The ﬁrst intravenous dose is 6 mg (0.1 mg/kg for children, maximum dose 6 mg). If the first dose is inefficient, adenosine at 12 mg IVP (pediatric dose 0.2 mg/kg, maximum dose 12 mg) can be given again. If the second dose of adenosine 12 mg IVP has no impact as well, it can be repeated. Each adenosine dose is followed by rapid saline infusion<a href="#accordion">[5]</a>. 
&nbsp;

<ul>
	<li>Other Medications</li>
</ul>

Patients with frequent SVT without a pre-excitation syndrome may need considerable maintenance with oral beta-blockers or calcium to maintain sinus rhythm. Usually, medications like diltiazem, esmolol, and metoprolol are prescribed<a href="#accordion">[5]</a>. 
&nbsp;

<h5>Alternative Therapy</h5>

Some individuals experience supraventricular tachycardia as a result of stress. Alternative and complementary therapeutic approaches help with stress reduction. It usually involves yoga and meditation. 
&nbsp;

Frequent occurrences or no treatment can deteriorate the heart over time and result in heart failure. A single episode can also result in cardiac arrest or coma in rare circumstances. 
&nbsp;

<ul>
	<li>Age &ndash; Newborns and young children; some subtypes are more prevalent in middle-aged or older patients</li>
	<li>Gender &ndash; Women, especially during pregnancy</li>
	<li>Health Condition &ndash; Include heart diseases (e.g., coronary artery disease, congenital heart defects), thyroid disease, diabetes, obstructive sleep apnea, and previous heart surgery</li>
	<li>Drug Use &ndash; Nicotine and other illegal drugs 
	&nbsp;</li>
</ul>

Modifying or changing certain habits can help prevent an episode from occurring if they cause SVT. For instance:

<ul>
	<li>Learning healthy ways to cope with or manage stress</li>
	<li>Quitting alcohol and smoking</li>
	<li>Reducing the intake of coffee and other caffeinated beverages</li>
	<li>Changing sleeping habits to get more rest 
	&nbsp;</li>
</ul>

Note: DO NOT stop taking the medication as prescribed by your doctor. 
&nbsp;

Key Points

<ul>
	<li>Supraventricular tachycardia (SVT) is a cardiac disorder marked by bursts of unusually rapid heartbeat.</li>
	<li>Episodes can last for a few seconds, minutes, hours, or (in exceptional circumstances) days.</li>
	<li>Episodes can occur frequently &mdash; a few times every day &mdash; or very rarely &mdash; just once or twice a year. 
	&nbsp;</li>
</ul>

[1] Khurshid S, Choi SH, Weng L-C, Wang EY, Trinquart L, Benjamin EJ, et al. Frequency of Cardiac Rhythm Abnormalities in a Half Million Adults. Circ Arrhythm Electrophysiol. 2018 Jul;11(7):e006273.

[2] Hafeez Y, Rodriguez BSQ, Ahmed I, Grossman SA, Haddad LM. Paroxysmal Supraventricular Tachycardia (Nursing). In: StatPearls [Internet]. StatPearls Publishing; 2021.

[3] Frommeyer G, Eckardt L, Breithardt G. Panic attacks and supraventricular tachycardias: the chicken or the egg? Netherlands Hear J. 2013;21:74–7.

[4] Tan ESJ, Chan SP, Seow S-C, Teo WS, Ching CK, Chong DTT, et al. Outcomes of supraventricular tachycardia ablation: results from the Singapore ablation and cardiac devices registry. Pacing Clin Electrophysiol. 2022;45(1):50–8.

[5] Patti L, Ashurst JV. Supraventricular Tachycardia. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.