What are the ways to manage supraventricular tachycardia?

Question

Hello doctor,

I am 41 years old, and for the past five years, I have been experiencing some heart issues. I was hospitalized for SVT (supraventricular tachycardia) five years ago. The medications controlled it for a while, but as I got older, gained some weight, and went through life changes, things started to change. It was also recommended that I have an echocardiogram, a stress test, and wear a Holter monitor, but I delayed them and only completed the tests a few months ago. My EF came back at 50 to 55 percent, my aortic valve showed regurgitation, and I have a murmur. Based on those results, my doctor increased my Metoprolol to 100 mg, twice a day.

Things were stable for a while, but gradually, my symptoms returned. Last night, I had chest pain and jaw pain, so I went to the ER. My troponin level was 2.4. The ER doctor did not contact my cardiologist or increase my medication, and my heart rate fluctuated between NSR (normal sinus rhythm), SVT, and SVPB (supraventricular premature beat supraventricular premature beat).

I have all my test results and plan to show them to my cardiologist tomorrow before heading to work. Should I be concerned? Was something missed? I was surprised that I was not given any medication to address the pain or control my heart rate, and I am still on the same dosage. The medication was in my system while all this was happening, yet it did not resolve anything.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

First, I recommend that you upload your reports, such as the echocardiogram, to assess the severity of your aortic regurgitation, and the electrocardiogram (ECG) to determine the type of SVT (supraventricular tachycardia) you experienced. This will help clarify whether it was PSVT (paroxysmal supraventricular tachycardia) or atrial fibrillation.

Based on your description, it seems you had a repeat episode yesterday, so additional medication, such as Diltiazem, should have been prescribed to help control your heart rate. Regarding the troponin level, you did not mention the unit—was it within the normal range or elevated? If it was within the normal range, there is likely no cause for concern, and your chest pain may have been due to the high heart rate.

An ECG would also have shown changes if a heart attack were the cause, so please upload your ECG for review. I suggest undergoing electrophysiological studies to accurately diagnose the type of arrhythmia, as this could lead to a permanent treatment in most cases. If your heart rate is still elevated, additional medication is certainly necessary. Also, your leaky valve likely is not severe since your diastolic blood pressure is not low.

I hope this helps. Please get back to me with the reports for a more informed opinion, and feel free to ask if you have any further questions.

Thank you.