Zio Monitor & SVTs

Hello All,

Hope you are doing well -- thought I would pop in to post an update and see if anyone else has encountered similiar issues.

As we continue to go down all of the avenues to investigate my vision/motion disturbance (which has gotten better, but not perfect), I recently was seen by an ENT specialist and also had a VNG and CDP test -- mostly passed with flying colors, outside of when they blew hot or cold air into my ears, then I was instantly put into vertigo for about 10 mins. Otherwise, I passed everything else.

My Neurologist is finishing up on my referral to the Mayo Clinic-- he is having me undergo another round of physical therapy (this time focused on my neck and shoulders), and then getting "sign offs" from my general doctor, the ENT specialist and my cardilogist.

One of the things he wanted Cardiology to rule out was these bouts of PVCs that I seem to be having. I have only had 1 or 2 a month that I could feel for the past few months (to the point of me ignoring them), but the day of my VNG and CDP tests I experienced about 30-40 incidents of what I would think is a PVC. I would feel a flutter/skipped beat in my chest and a 1 second shortness of breath. I was having them so frequently that I was able to catch the "drops" on my Apple Watch. I forwarded to my cardiologist and one of the nurses said that it definitely looked like a PVC and that she would review with my actual cardiologist.

Then on Sunday morning (yesterday) around 4:30am I woke up to go to restroom and noticed my heart was at about 167bpm and it would NOT go down. I tried sitting down, standing up, drinking water, breathing exercises etc and for whatever reason it was high and then I noticed the chest pains.

Started chewing on baby aspirin as my wife drove me to the ER. They couldn't find anything concrete (labs came back fine, chest CT looked great, etc). but said that I was having SVTs and that most are non-fatal, but that they can be dangerous if there is something else going on.

I was fitted with a Zio heart monitor for the next 2 weeks to see if they can find anything. Luckily for me, I have had a few of those PVC feelings since being fitted with the device, so I was able to press the button to "record/focus" on that time period. 

Hopefully I don't experience another SVT as that was extremely uncomfortable, but I guess on the flip side, I'd rather experience all of this stuff now, while the device is on me, so we have actual data to look at.

I think I was experiencing these SVTs shortly after the PM implant last year, but they chalked it up to anxiety and stress (which I can't argue with, I was not in a great mindset).

I am going to continue to stay hydrated, get proper sleep and to exercise frequently. I have been trying to keep a balanced eye on my diet and I drink zero alcohol, never have consumed tobacco and rarely consume caffeine (I like to drink a V8 Fusion in the morning, which is a mix of fruit and veggies, but now also a dose of "green tea"). I wish V8 Fusions still came without the tea, as I don't care for the taste nor the caffeine, but I love the fruit/veggie mix that I get from it.

Anyways, I hope all is well and I am curious to hear from others that have maybe been in the same boat. If my doctors find weird bouts of SVTs or PVCs....is there really anything they can do about them? I'm excited to be able to have raw data to compare with how I am feeling, but I am worried that it will be a "wait and see" type of situation.

It is frustrating because I spent 5 hours in the ER and they pretty much said there was nothing they can do and to go home and "keep an eye on it". The conflicting advice was, "if you feel your heart going over 120-140 without any sort of exercise and you experience chest pains, then you might just be having an SVT. Try to splash water on your face, try a few exercises to calm it down and relax and DON'T stress....they do pass". But then they also say "if you're heart rate is above 120-140 for more than a few mins OR you experience chest pains, call 911 or come in immediately".

It makes it very difficult to determine what I should do, should another incident arise. I'd rather be safe than sorry, but if they're going to look at me and say they can't do anything for me, then why waste the drive in, the time waiting and the cost of the insurance co-pays?

Take care

Jer


9 Comments

SVT home remedies

by Gotrhythm - 2022-08-01 12:17:18

"Bearing down" often will stop an SVT episode for me.

Worth a try.

What to do when you feel unwell

by Gemita - 2022-08-01 12:45:39

Jer, thank you for the update and I am sorry you are having palpitations.  As an arrhythmia sufferer, I know just how difficult these can be to tolerate.  I am having a period of unusual arrhythmia activity and it is affecting my quality of life.  I am in touch with my GP, Pacemaker Clinic and EP and I hope I can get them back under control.

With an arrhythmia, the best advice I can give you is that if at any time you feel you need help, then please get help.  Either call an ambulance or get yourself into ER where you can be fully assessed.  This is what my arrhythmia clinic advised me to do, especially when I first developed symptoms of an arrhythmia, before they identified the arrhythmia(s) present.   Symptoms to watch out for would be breathlessness, chest pain, instability (feeling weak, fatigued, dizzy, faint, anxious, sweaty), having a high heart rate and noticing swings in blood pressure - both low and high.  A high heart rate with a heart condition could be dangerous if the heart rates cannot be controlled.

By attending ER when you feel poorly will tell them that you are extremely symptomatic from your palpitations and that these will need better control.  Unless you keep up the pressure, they may assume you do not need help which would appear to be far from the case.

So, go by how you feel and you won’t go wrong.  Only you will know your limits, what you can and cannot tolerate and no doctor can really know “how you are feeling”.  Always err on the side of caution in the beginning until your arrhythmias are under control and your doctors have diagnosed the problem.  It goes without saying that electrolytes, thyroid function should be checked, you should keep well hydrated as well.  Since different rhythm disturbances may need different treatments, diagnosing the precise type of arrhythmia is important Jer.

Don't look too far ahead with treatments, take one small step at a time.  Get to know what you are dealing with first, control it if you can.  if you cannot, then consider all treatment options with your EP.  Hope the monitoring gives good information.  Good luck as always Jer

What to do about SVTs or arrhythmias in general?

by Gemita - 2022-08-01 14:12:38

Yes it is often a watchful wait policy to see if arrhythmias progress, when intervention might be necessary.  Palpitations fortunately are often intermittent and short lived, so why go in too heavily?   Leaving well alone and controlling rate in the case of an SVT may be all that is necessary initially.  For years I have been controlling atrial tachy arrhythmias with a beta blocker or with home remedies successfully.

If you are feeling stable and your doctors agree, try a few vagal maneuvers when you notice a fast arrhythmia: 

(1) Hold your nose, close your mouth, and try to blow the air out. This creates pressure in your chest that may activate the vagus nerve. Try it for 10 seconds.

(2) You could also try coughing hard to generate pressure in your chest which will stimulate the vagus nerve too.  Coughing works well for me as does the bearing down technique Gotrhythm suggests, but perhaps try these techniques with a doctor first.

Positional changes are also helpful.  Standing from lying, lying from standing, turning from side to side while lying.  Sounds crazy I know, but simple measures may just work occasionally to stop any arrhythmia before it takes hold

Your update

by Lavender - 2022-08-01 15:34:18

Jer, I have been reading your posts since I found the group. It's good to see you updating and it sounds like you're getting more diagnostic help. I read this: The long-term Zio monitor detects over 99% of arrhythmias in 14 days compared to only 47% captured by short-term Holter monitors in 2 days.

Your team sounds like they are lifting every stone to see what lies under. 
 

For a while, I was diagnosed with vestibular issues and went through several weeks of therapy so I understand some of what you've done thus far. Of course in my case, the anxiety I was having was building up from the fainting and fear of fainting before they found my ventricular standstill issue. 
 

I get so itchy wearing those electrode patches for monitoring as well as the ones for ekgs that I now have my own packs of the stick ons that are hypoallergenic. I bring them along if I am going into the hospital. 
 

You always tell it like it is and, although you deal with the anxiety, you're intelligent and keep seeking solid solutions. Let us know what the monitor discovers!

oh! And I have to say that a neurologist was the one who kept insisting it was my heart causing the six months of fainting I experienced. He had early on asked for a shorter term heart monitor for me which I wore with no events.  He did not give up and demanded that I get a thirty day heart monitor. The cardiologist said it wasn't necessary and insurance wouldn't cover.  The neurologist got my pcp to order it anyway. That was what caught my ventricular standstill. I sent the neurologist a thank you for not dismissing me and being so dedicated to finding my problem. So, I am happy to read how thoroughly your neurologist is dealing with you.  
 

I hear you on going to the ER. I was sent home several times and told nothing was wrong and get used to it. One ER doc actually told me we all have to deal with some level of pain😡

Keep at it Jer! Answers will come!

Appreciate the Comments

by MinimeJer05 - 2022-08-01 16:20:31

Gotrhythm, Gemita and Lavender -- Thank you for the positive comments and feedback.

I will try the suggested exercises and I will stay on top of the responses that I am feeling to keep things in control -- It's always so tricky finding the balance of "I am going to be okay" or "I should probably go to ER" -- luckily for me, the ER that I am suggested to go to is only 20-30 mins away and my wife works from home 100% of the time, so I generally always have someone that can drive me. I'm always so worried about calling the ambulance as I I hear horror stories about insurance not covering them in the USA. I personally never have called one....so I am not sure how true that is?

I feel somewhat more reassured knowing that the 14-day monitor might be giving us a better picture of what is going on as I feel like up until this point, cardiology has been consistently reporting that my pacemaker is doing just fine and that my heart looks good (which I hope both to be true, despite it making these feelings harder to explain or make sense of).

I will say my Neurologist has been very vocal about not being happy with not being able to give me a direct diagnosis and definitely wants to leave no stone unturned -- he even had me alter my diet and take some supplements (B2 + Magnesium) to see if that has helped improve things (I cut out what little dairy I was consuming and don't eat any dark chocolate (again not something I ate much of). At this point, I just keep trying to do what I can to get answers and hope that these crappy days are soon behind me.

The PVCs don't worry me nearly as much as the SVTs, but I guess both are cause for concern if not treated or better understood.

I am going to try going for a nice walk this afternoon to relieve some stress and to keep at that cardio activity. 

:)

Take care

Jer

SVT

by Rch - 2022-08-02 03:18:57

Did the ER give you any medications to control the SVT? 

One of the home remedies you could try for SVT is modified valsalva maneuver. You could look it up on the You Tube. The authors claim 43% termination rate! 

Self help measures to try to stop SVT

by Gemita - 2022-08-02 04:46:21

Jer, the attached links should help further.  Be sure to look up the REVERT trial on postural modification published in the Lancet, first link below:-

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61485-4/fulltext

and there is more info on this excellent You Tube video as already suggested by member Rch explaining why it can work.  (I have tried lying on bed and placing legs up against wall to achieve elevation while carrying out other vagal manoevers too).

https://m.youtube.com/watch?v=CpN-9fG64GA&pp=QAFIAQ%3D%3D

Of course you will ideally need a diagnosis of SVT first (Atrial Fibrillation or Atrial Flutter would not perhaps be managed by this manoever alone although certainly still worth a try if these arrhythmias are vagally induced.  You would of course need to be fairly stable to perform this manoever, perhaps as soon as your SVT starts before you start noticing troublesome symptoms. 

Cannot remember if you are taking a low dose beta blocker to quieten everything down (Metoprolol?) since sometimes daily prevention is often better than cure or allowing an arrhythmia to become established

Thanks For Links!

by MinimeJer05 - 2022-08-02 11:14:44

Rch and Gemita -- thank you for these tips and links. I have bookmarked them to view after work. I love finding things on YouTube that can help...sounds so much easier than going in or having to take additional medications.

Rch -- the ER did not give me any medications.

Gemita -- I am taking Metoprolol (50MG in morning and 50MG in evening).

Jer

Jer

by Gemita - 2022-08-02 11:45:05

2 x 50 mg of Metoprolol daily should be enough to "help control" a fast arrhythmia like SVT and your doctor would still have the option of going higher if he needed to, so you are on a good treatment regime already.  Now add the vagal manoevers to the mix and that would be a strong cocktail of measures against the odd SVT episode.  If they increased or lasted longer, then the next stage would be an electrophysiology study to see where the SVT trigger is located, followed by an ablation, but this stage hasn't been reached yet Jer.  Good link on SVT to read:-

https://www.mayoclinic.org/diseases-conditions/supraventricular-tachycardia/symptoms-causes/syc-20355243

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