Case Study of an Supraventricular Tachycardia Patient

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Case Study of an Supraventricular Tachycardia Patient



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The Symptoms

Referral to a Cardiologist

More Symptoms

Trip to A & E

Referral back to a Cardiologist (Catheter Ablation)

Catheter Ablation (Second Attempt)

Referral to another Cardiologist (Third Ablation)

Conclusion
Jill

Age. 42


Diagnosis - SVT



The Symptoms

I first noticed my heart do something very strange one evening about 12 years ago. A friend and I were playing squash; I bent down to pick the ball up and immediately felt very strange. My heart was beating very, very fast; it felt out of control, you could see the movement through my T-shirt. I felt panicky and scared, I thought something awful was going to happen, I didn’t want to draw attention to myself or cause a fuss. My husband was on the next court and suggested that he took me to A & E. Just as we left the sports centre car park my heart went back to normal just as suddenly as it had started. The whole thing had lasted no more than 15 mins. There seemed to be no point in going to A & E, the problem had gone and I felt a bit stupid for some reason, I almost felt like I had imagined it all.

The next year I went skiing as usual having had no more palpitations and eventually forgetting about the squash episode. On the third day of the holiday I fell quite heavily. Immediately my heart started palpitating as it had done before, I felt shaky and light headed. The only way back down the mountain was either to ski or by blood wagon, (ski medics ambulance, skiing at speed whilst carrying you on a stretcher) not much of a choice really. So I slowly skied down to the bottom where my husband and friends were waiting, they wanted to know why I had been so long. Saying I was tired, I went back to the apartment and lay on the bed, hoping that every thing would go back to normal as it had done the previous year. By the time my husband and friends got back I had got myself into a bit of a state, my heart had been palpitating for about 1½ hours. The paramedics came and did several ECG’s, and then they took me to the hospital. Communicating in broken French and English I was told that the problem might have been caused by the altitude and to see my GP when I got home. When my heart rate had gone back to normal I was allowed to go back to the room and told to take it easy the next day although it was ok to ski.


Referral to a Cardiologist

Back home my GP referred me to a cardiologist and I was given an exercise test (this enables the heart to be put under pressure whilst being monitored) and a 24-hour heart monitor. Neither of these showed up any problems with my heart. Although I should have felt relieved, I didn’t. I knew there was something wrong with me but no more tests were suggested and I felt like that was an end to it as far as the cardiologist was concerned.


The following year my mother died, it was a very harrowing time and I struggled to cope. Finally later that year I had a breakdown. After months of resisting anti-depressants, and trying all kinds of alternative therapies, I had got to the stage where I would take anything to get me out of this big black hole of despair. During this time I was also having short episodes of palpitations, lasting seconds. In fact some were so short it was almost as if I had imagined them.



More Symptoms

As the years passed by the short episodes became more frequent; I also had long episodes that lasted about 3 hours. These started with just 1 or 2 a year but built up to about 9 a year. Most of these seemed to happen when we were on holiday, my husband suggested that it may be all the rushing about before hand and the stress of the flight (I’m not keen on flying). I became more and more anxious about going on holiday; worried that something awful was going to happen. My husband and my best friend (the only other person I had actually confided in) were full of support and reassurance.

Over past years several things had been suggested as to why the palpitations occurred. These included too much caffeine, panic attacks, not enough exercise and too much stress. I became more and more angry with myself when the palpitations occurred because I felt it was my fault, I had some way made it happen. My life had become less and less enjoyable; I started to avoid the things that I knew could start the palpitations. I felt very vulnerable away from home; I had constant conversations in my head. What if it happens now, what will I do, I might pass out, what if I need a doctor, where is the nearest hospital, what if they don’t speak English, what if I’m driving or in a plane going across the Atlantic? The what ifs were endless. At the same time the more positive side of me was saying, it will be ok, nothing awful has happened to you before, the palpitations have always gone off, stay calm and it will not happen, forget about it.

I stopped taking the anti-depressants and almost a year later had another breakdown. I was put back on to the tablets and referred to a counsellor. On my second visit I managed to tell him about my problem, I felt embarrassed and stupid; I asked him what he thought was wrong with me. I told him it was impossible to take a pulse because my heart was beating so fast. He thought that it was unlikely to be a panic attack if my heart was beating that fast and that the best thing to do was to go to A & E the next time it happened so that an ECG could be done whilst my heart was still palpitating. For this advice and the fact that I was being believed and not being seen as the neurotic female I felt I was turning in to, I will always be grateful.





Trip to A & E
On January 4th 2004 I was getting off my exercise bike after doing my usual ½ hour and my heart started to palpitate. I looked down at the heart monitor I had been wearing whilst I was exercising and it said 236 b.p.m. Up until now I had not actually known how fast my heart had been beating during these episodes, I felt very panicky. My husband drove me to A & E where I was very quickly put on a bed and my heart was monitored. The results of the ECG suggested that I was suffering from Supraventricular Tachycardia (SVT for short). This is an extra pathway in the heart that enables the electric impulses to short circuit making the heart beat very fast. At last it had a name. To get the heart beating normally again I was injected with a drug and told I would not feel very well for about 30 seconds. The feeling was of doom and impending death. The first one did not work nor the second. After increasing the dose each time the third one worked and my heart rate gradually started to come down. I was prescribed beta-blockers and went home.

Referral back to a Cardiologist

Catheter Ablation

I went on my annual skiing holiday 2 weeks later and for the first time for 12 years my heart did not palpitate whilst I was there. On my return I had several consultations with cardiologists who explained about SVT and my options. I decided that if it was possible I wanted to be free of the problem once and for all. So on the 8th May 2004 I went into hospital for an ablation of the accessory pathway. After several hours the extra pathway had not been found but was thought to be very close to the normal pathway. If this turned out to be the case it could prove tricky to ablate, with the risk that both pathways could be ablated, this resulting in a pacemaker having to be fitted. I was very disappointed and to my horror cried (not easily reduced to tears normally) when I was told that no ablation had taken place. I was told that some equipment was coming to the hospital later on in the year that could freeze the pathway and could be reversed if both pathways were closed by mistake. Could I go through with it again? It wasn’t the fact that the procedure was painful because it was not; it was the disappointment of the ablation failing again that I feared. After some encouragement from my husband and friend I decided I would have another go.


Catheter Ablation Second Attempt

The second attempt was done on 27th September 2004 by the same cardiologist at a different hospital. This time the method of freezing the extra pathway was to be used. After several hours the extra pathway had not been found and it was suggested that it might be in the upper left side of the heart.


At this hospital I was very lucky to meet two other people that were having the same procedure done. One was successful, but unfortunately the other like me was not. It was great to meet other people that were going through the same thing, especially emotionally.
Referral to another Cardiologist

Third Ablation

I was referred to another cardiologist who would be able to have a look into the left upper side of the heart. The ablation was arranged for 12th March 2005. Having already had the procedure done twice I felt a lot more relaxed and less expectant of the out come. In fact I think I may have fallen asleep at some point during the 4½-hour procedure. As it turned out the extra pathway was found in the right hand side of the heart after all and an ablation was done. Unfortunately, the cardiologist was still able to make the heart palpitate for short periods of time.




Conclusion

Now two months on, although it is still early days, I am off the medication and have had no long episodes. Unfortunately the short ones, lasting less than a minute are still persisting and it looks like I am stuck with these. At the moment I am feeling quite optimistic and think I can cope if things stay the same. Lets face it life is never perfect and sometime you just have to move on and get on with it regardless.








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