I first heard of paroxysmal supraventricular tachycardia or PSVT less than two weeks ago while lying on the examination room bed of the medical center of a cruise ship.
My husband and I were on our first cruise, something I had wanted to do for many years even before I reached the age of the retirees who frequent so many cruise ships. It was on the fifth day of our ten-day cruise when I lost track of my two cousins and their husbands after we had taken a brisk walk on the Promenade deck and then headed up to the Lido deck for breakfast. I knew my husband had gone to the medical center to see if he could get something to deal with his cold symptoms, but I hadn’t planned to join him there. But since I couldn’t find my cousins – these ships are huge – I sat down at a small table with my cup of coffee and carton of yogurt, thinking I would eat the yogurt to get something into my empty stomach and then I’d go on a more systematic search for the rest of my group.
I had only taken one spoonful of yogurt and one sip of coffee when I recognized the signs that my body had been hit by a dose of adrenaline — narrowed vision, a familiar and awful taste into my mouth, and feeling that the only thing I really wanted to do right then was lie down on the floor of the dining area. And then my heart started racing. I have experienced these episodes before, but had always been able to stop them by holding my breath. This time, that trick didn’t work.
Another symptom of adrenaline attacks is a lack of clear thinking. As I sat alone at my table, I knew I couldn’t lie down on the floor, and I knew that I wouldn’t be able to begin looking again for my cousins, but it took a long time for my brain to reach a conclusion of what I could do. I felt glued to my chair until I finally decided I just had to get up and back to our cabin where I hoped I could lie down and bring my racing heart under control. I managed to get to an elevator, but I had headed to the wrong end of the ship – in the direction away from our cabin. I was still disoriented when the elevator stopped, so I continued to walk away from our cabin, my eyes focused on the floor, not on the numbers on the cabin doors that would have provided a clue to my misdirection. When I reached the far end of the ship and realized what I had done, all I could think to do was sit down on the floor and try to keep myself from crying. My heart was still racing and now I had to walk all the way to the other end of the ship. I hoped that my husband would be back from his trip to the medical center.
I dragged myself to the other end of the ship and discovered my husband wasn’t in the cabin. Over and over again I tried holding my breath to see if the rigid shape of the muscles around my heart would stop the racing. I managed to count the number of beats, using the second hand on my watch for 15 seconds to determine my heart was beating at well over 200 beats per minute.
My heart had been racing for at least 30 minutes by the time my husband came into the cabin to see if I was there. He had run into my cousins on the Lido deck and they told him they were worried about where I was. With the help of the family in the neighboring cabin who had a wheelchair for their father, my husband got me to the medical center where the staff hooked me up to an IV for fluids and an EKG to record the evidence of my racing heart. The first EKG involved six leads. When the doctor arrived in the room, she ordered a 12-lead EKG and gave me the most important suggestion of the day: the Valsalva maneuver, a variation of the holding-my-breath maneuver I had discovered on my own. The doctor advised that I hold my breath and bear down at the same time, as if trying to. . . well, I’m sure you get the picture. I did that and didn’t think it had any effect, but just as the nurse got the 12 leads connected and was about to press the button to start the second EKG, my heart stopped racing. The difference was so noticeable to me that I felt everyone in the room should have been able to hear it happen. But they were all still focused on the EKG, so I told them my heart rate was back to normal. And I saw all three of them visibly relax.
Since I have experienced these episodes before, I was a little surprised at how concerned the three medical staff members seemed. Eventually one of the nurses explained that if I hadn’t been able to get my heart to stop racing, they would have had to inject a chemical to force the heart to show down and that procedure often has some unpleasant side effects. She also explained that my heart rate had been 225 beats per minute and that when the heart beats that fast, there isn’t time for blood to get into the heart chambers to be recirculated throughout the body. So while the heart was racing, it wasn’t doing what it is supposed to do and my blood pressure was dropping and my complexion was getting paler and paler on that examination room bed.
I decided I needed to learn more about SVTs – the nurse explained that the P just means the SVTs happen periodically without any obvious cause.
- First, it was reassuring to learn that most SVTs, while unpleasant, are not life threatening. In my case, there was no pain associated with the episode and it was not therefore a heart attack.
- Second, there are many maneuvers that may help stop the racing in addition to holding my breath or the Valsalva maneuver. Coughing, sticking the face into cold water, drinking a glass of ice cold water, standing on one’s head, and pressing down gently on the top of closed eyes are recommendations I might try next time. Well, maybe not the standing on my head option.
- Third, there are medicines that help prevent the episodes. The doctor gave me one of them, metoprolol, which blocks the action of the involuntary nervous system which reduces the heart rate. Whether I need a daily medication to control an event that has happened about once every two years is something I will discuss with a cardiologist, once I get a referral to see one locally.
- Fourth, there are other interventions involving insertion of a catheter to deliver radio frequency energy to destroy abnormal electrical pathways within the heart. While these treatments are highly effective, I hope not to have to explore such options, especially since insertion of a permanent pacemaker has been required after such treatments in a small percentage of patients.
The most distressing aspect of my SVT episode on the ship was the advice the doctor gave that I consider leaving the ship either that day or on one of the following two days, our last days in ports, to return directly home. She warned me that our final two days would be entirely at sea, leaving me with no option to leave the ship at that point. I still don’t know if it was the cost of leaving early or the loss of the experiences of the second half of the cruise that was the bigger part of my concern as I spent the next day deliberating those options.
For more information about PSVTs, see http://www.medicinenet.com/paroxysmal_supraventricular_tachycardia_psvt/article.htm