paroxysmal supraventricular tachycardia

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 


cruising in the caribbean

Cruise ship - Radiance of the Seas by blmiers2, on Flickr
Creative Commons Attribution-Noncommercial-Share Alike 2.0 Generic License  by  blmiers2 

We are seniors. We have been for awhile. And taking cruises is something seniors do. In the winter, many of those seniors go cruising in the Caribbean, where the weather is warm and shopping is duty free.

I had been fascinated by the idea of taking a cruise long before I joined the ranks of seniors. I first wanted to take a cruise since before I joined the ranks of teenagers, in the days of that TV classic from the late 50’s, The Gale Storm Show: Oh Susannah. Finally, last month, my husband and I headed off for ten days on a cruise involving stops at six islands interspersed with three days at sea. I was so excited.

We were with two of my cousins and their husbands and were joined for evening meals and many other events by a couple my cousins had met before who have enough nights of sailing with the cruise line we were on to be five-star passengers. The six of them had been on many cruises before. But we were newcomers. There were so many things we didn’t know, even though my cousins and their husbands tried to fill us in.

Maybe the fact that we didn’t have to do our own research was part of our difficulties. My cousin’s husband had checked out the price, the route, and the time of the year, concluding that the price was great, the route would take us to lovely ports, and the time of year would guarantee us pleasant weather. He was right, but that wasn’t enough for our first cruise.

Here is what we learned from our experience.

  • Be prepared to experience motion sickness. No matter how big those ships are, the bow will be bobbing along in the water at some point and that motion can be difficult to adjust to. It is no surprise that the dining rooms are at the back of the ship, where the motion isn’t quite as extreme. Bring motion sickness medicines along. There will be some available on the ship, too, but those shops are like mom-and-pop shops everywhere, limited in what they offer and the prices are high.
  • Start from somewhere close to home. Our ten-day cruise originated on the east coast. We live on the west coast. So our first travel day was consumed just getting across country. And our first flight was delayed by hours because of mechanical problems, putting us at risk of not making our connection or arriving on time, not the carefree beginning to our vacation we had hoped for. And the return trip was even more stressful.
  • Start with a short cruise. This may seem counter-intuitive since it will cost a packet of money for a vacation and longer vacations always seem better than short ones. But we both concluded we should have tried a five-day, not a ten-day, cruise for our first one. Had we not been on the ship for so long, we would likely have enjoyed all of our cruise, instead of just the first half. That’s because. . .
  • Cruise ships are confined and confining places where it is difficult to get away from anything unpleasant. And what was unpleasant for us was the viral infections we both picked up. For the final five days of the cruise, we couldn’t take part in many of the activities we had been looking forward to because our coughing disrupted those around us. In addition, the virus robbed the food – the exquisitely prepared and oh, so plentiful food – of its flavor.
  • Remember that not everything comes with the cost of the room. Meals are included – and as I had expected, there was plenty of food at all the hours we were awake. But everything else beyond food comes with a price tag. It isn’t that the prices were all high – drinks were about what we pay for them back home. But we don’t go out to have cocktails ten nights in a row back home. On the ship, that’s what we all did. And the Love Boat series that included Dr. Bricker as one of the main characters never prepared us for the cost involved in visiting the ship’s medical center. For what we paid for our medical bills – thanks to my PSVT episode – we could have brought along another passenger or taken another shorter cruise. And it happened on the fifth day – what would have been our departure day had we opted for a shorter cruise.
  • Be aware that people on cruises – both passengers who have been on them before and the staff – speak a different language. We didn’t know what the Lido deck meant. Everyone else knew that was the top deck where the buffet and the swimming pools were. I checked what I thought was the right box on the form to arrange for our disembarkation but when we were advised to be ready to leave the ship at 7:30 a.m. while our flight out of town wasn’t until 5:00 p.m., I thought they had made a mistake. When I called to ask why we had been told to be ready to leave so early, the helpful man at the other end of the phone explained, seemingly with great pleasure, that we had been approved for the Luggage Direct program. I had no idea what that meant except that it required us to leave much earlier than we wanted to. We didn’t know the difference between Expedited Departure and Luggage Direct, so we showed up to disembark with the wrong group. I thought a 7:30 a.m. departure time was pretty darn expedited, but we had to wait for the expedited departure folks to leave first. Once we figured out the language of cruises, I realized that what people told us was accurate, but it was as if they had been throwing Finnish words into the middle of English sentences.
  • No matter what clothes you bring along, you’ll need different ones. I had bought three pairs of walking shoes to be sure I had good ones for walking around in port. The first pair bruised the top of my foot before I even set foot on the ship. The second one had decorative holes along the top – I thought it would be good to have shoes that could breathe. Each edge was the source for rubbing my toes, resulting in blisters. Thankfully I bought a pair of walking shoes on the ship – at a lower cost than any of the pairs I brought with me – that served for part of the time. I had to buy another pair when the blisters on my toes made it clear I was not going to make it back to the ship if I didn’t get out of that pair. And I hadn’t brought along dressy shoes for the three formal evenings. I made do with the third pair of walking shoes that could pass for ballet slippers.
  • Be prepared to pony up plenty of money for anything off the island. Sure, it was possible to just walk off the ship and walk around town – each port offering essentially the same shops, all duty free, all offering goods I don’t need and wouldn’t use – but anything beyond that came with price tags per person in excess of a couple of hundred dollars. The one excursion my two cousins and I took together was a slightly lower price and I can’t imagine that any of the other offerings could have topped it. We went zip lining across the jungle canopy of the Dominican Republic.
  • Check for where the smokers spend their time. On our ship, smoking was permitted around the outdoor swimming pool on the Lido deck – at the back of the ship – and on the verandas of the staterooms. Unfortunately, the couple in the stateroom just forward of ours were smokers. Every time we opened the door to spend time on our veranda, we heard one of them open their door. And then the smoke wafted from their veranda to ours. I wish we had asked to swap staterooms with them on the first day. I didn’t think of that until the end of the cruise.
  • Are we sorry we went on the cruise? Not at all. It was a wonderful opportunity to reunite with my cousins and their husbands. And we met other great people as well. Besides, it was on my bucket list.

    Will we go on another cruise? Maybe. But unless taking a cruise is the only way to get somewhere we really want to go, I think we’ll opt for an all-inclusive package where we can stay in one place or go out somewhere else as we want to, not according to the ship’s schedule.