Topic Overview
Is this topic for you?
Atrial fibrillation and ventricular tachycardia are
types of fast heart rates that can be serious. If you have one of these heart
problems, see the topic
Atrial Fibrillation or
Ventricular Tachycardia.
What is supraventricular tachycardia?
Supraventricular tachycardia (SVT) means that from time to time your
heart beats very fast for a reason other than exercise, high fever, or stress.
Types of SVT include:
During an episode of SVT, the heart’s electrical system
doesn't work right, causing the heart to beat very fast. The heart beats at
least 100 beats per minute and may reach 300 beats per minute. After treatment
or on its own, the heart usually returns to a normal rate of 60 to 100 beats a
minute.
SVT may start and end quickly, and you may not have
symptoms. SVT becomes a problem when it happens often, lasts a long time, or
causes symptoms.
SVT also is called paroxysmal supraventricular
tachycardia (PSVT) or paroxysmal atrial tachycardia (PAT).
What causes SVT?
Most episodes of SVT are caused by
faulty electrical connections in the heart 
. What causes the
electrical problem is not clear.
SVT also can be
caused by very high levels of the heart medicine digoxin (such as Lanoxicaps or
Lanoxin) or the lung medicine theophylline (such as Theochron or Uniphyl).
Some types of SVT may run in families, such as
Wolff-Parkinson-White syndrome. Or they may be caused by a lung problem such as
COPD or
pneumonia.
What are the symptoms?
Some people with SVT have no
symptoms. Others may have:
-
Palpitations, a
feeling that your heart is racing or pounding.
- A pounding
pulse.
- A dizzy feeling or may feel
lightheaded.
Other symptoms include, near-fainting or fainting (syncope), shortness of breath, chest pain, throat
tightness, and sweating.
How is SVT diagnosed?
Your doctor will diagnose
SVT by asking you questions about your health and symptoms, doing a physical
exam, and perhaps giving you tests. Your doctor:
- Will ask if anything triggers the fast heart
rate, how long it lasts, if it starts and stops suddenly, and if the beats are
regular or irregular.
- May do a test called an
electrocardiogram (EKG, ECG). This test measures the
heart's electrical activity and can record SVT episodes.
- May do an
electrophysiology (EP) study. This test finds out whether there is an extra
electrical pathway inside your heart.
If you do not have an episode of SVT while you're at the
doctor's office, your doctor probably will ask you to wear a portable EKG. When
you have an episode, the device will record it.
Your doctor also
may do tests to find the cause of the SVT. These may include blood tests, a
chest
X-ray, and an
echocardiogram, which makes a picture of the heart.
How is it treated?
Some SVTs don't cause
symptoms, and you may not need treatment. If you do have symptoms, your doctor
probably will recommend treatment.
To treat sudden episodes of
SVT, your doctor may:
- Prescribe a medicine to take when the SVT
occurs.
- Show you how you can slow your heart rate on your own. You
may be able to do this by coughing, gagging, or putting your face in ice-cold
water. These are called vagal maneuvers.
If these treatments don't work, you may have to go to your
doctor's office or the emergency room. You may get a fast-acting medicine such
as adenosine or verapamil. If the SVT is serious, you may have
electrical cardioversion, which uses an electrical
current to reset the heart rhythm.
If you often have episodes of
SVT, you may need to:
- Take medicine every day to prevent the
episodes or slow your heart rate.
- Try catheter ablation. This
procedure removes a tiny part of the heart that causes the problem.
What can you do at home to prevent SVT?
You can do
a lot to prevent SVT by avoiding the things that trigger it.
- Limit alcohol to 2 drinks a day if you are a
man and 1 drink a day if you are a woman.
- Limit caffeine. Even
decaffeinated teas or coffee can cause SVT in some people.
- Don't
smoke.
- Avoid over-the-counter decongestants, herbal remedies, diet
pills, and "pep" pills.
- Don't use illegal drugs, such as cocaine,
ecstasy, or methamphetamine.
To find your triggers, keep a diary of your heart rate and
your symptoms. You might find, for example, that smoking or caffeine causes
your SVT episodes.
Health Tools
Health Tools help you make wise health decisions or take action to improve your health.
Frequently Asked Questions
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Being diagnosed:
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Cause
Two common types of
supraventricular tachycardia—atrioventricular reciprocating tachycardia (AVRT) and
atrioventricular nodal reentrant tachycardia (AVNRT)—are caused by an abnormal
electrical pathway in the heart and often occur in
people who do not have any other type of heart disease. What causes this
abnormal pathway is not clear.
Some experts believe that
AVRT—specifically
Wolff-Parkinson-White syndrome—may in some cases be
inherited.
Other types of supraventricular tachycardia may be
caused by:
- Atrial cells firing off signals rapidly (called
atrial tachycardia). Atrial tachycardia is seen most often in people with
structural heart disease.
- Overly high levels of the
heart medicine digoxin (such as Lanoxicaps or Lanoxin) or the
bronchodilator theophylline (such as
Elixophyllin).
- Other serious health problems, such as
chronic obstructive pulmonary disease,
heart failure,
pneumonia, or metabolic problems.
Symptoms
Symptoms of
supraventricular tachycardia include:
What Increases Your Risk
Some lifestyle factors can
raise your risk of having an episode of
supraventricular tachycardia, such as overuse of
caffeine, nicotine, or alcohol or use of illegal drugs, such as stimulants like
cocaine or methamphetamine.
Decongestants that contain stimulants
should also be avoided, including oxymetazoline (such as Afrin and other
brands) and pseudoephedrine (such as Sudafed and other brands). Doctors also
warn against using nonprescription diet pills or "pep" pills, because many
contain caffeine, ephedra, ephedrine, the herb ma huang, or other
stimulants.
Conditions that affect the lungs, such as
chronic obstructive pulmonary disease (COPD),
pneumonia,
heart failure, and
pulmonary embolism, can raise your risk for multifocal
atrial tachycardia (MAT), a type of supraventricular tachycardia.
Many experts believe that
Wolff-Parkinson-White syndrome may in some cases be
inherited. If you have a first degree relative, which is a parent, brother, or
sister, with this disorder and he or she has symptoms, talk with your doctor
about your risk of developing this abnormal heart rhythm.
When to Call a Doctor
Call
911
or seek emergency services immediately if you have a fast heart rate and
you:
- Faint or feel as though you are going to
faint.
- Have severe shortness of breath.
- Have chest
pain.
- Have symptoms of a heart attack or stroke.
Call your doctor if you are having fluttering in your chest
(palpitations) that persists and does not go away quickly or if you have
frequent palpitations.
Watchful Waiting
If you have a fast heart rate and
you have symptoms that may be caused by the fast heart rate, watchful waiting
is not appropriate. See your doctor.
Who to See
Health professionals who can evaluate symptoms of a fast or irregular
heartbeat include:
Most people with
supraventricular tachycardia need to see a
cardiologist or electrophysiologist for follow-up care.
Exams and Tests
An exact diagnosis is important
because the treatment you receive depends on the type of tachycardia you have.
Supraventricular tachycardia can sometimes be
diagnosed simply on the basis of a
medical history and physical examination and a few
simple tests. The physical exam may include a
carotid sinus massage. Tests that may be done to
monitor your heart and diagnose the type of fast heart rate that you have
include:
-
Electrocardiogram (EKG, ECG), which measures the electrical impulses in the heart. If an
electrocardiogram is performed while the fast heart rate is occurring, it often
provides the most useful information.
-
Ambulatory electrocardiogram. A portable EKG, such as a Holter monitor, can record
your heart rhythm on a continuous basis, usually over a 24-hour period. If your
symptoms are infrequent, your doctor may use another type of ambulatory
electrocardiogram called a cardiac event monitor. When you have symptoms, you
activate the monitor, which records your heart rhythm.
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Electrophysiology study. In this test, flexible wires are inserted into a vein, usually in
the groin, and threaded into the heart. Electrodes at the end of the wires
transmit information about the heart's electrical activity. This information is
used to determine whether there is an extra electrical pathway inside the heart
and, if so, where it is located. Catheter ablation can be done during this test
to treat abnormal pathways and correct the supraventricular
tachycardia.
- Medicine trial. Giving certain medicines while you are
experiencing a fast heart rate, and monitoring what happens, may sometimes help
your doctor determine what type of fast heart rate problem you have.
After finding tachycardia, your doctor may need to search
for its cause. The specific tests needed depend on the particular tachycardia.
These tests may include:
Treatment Overview
Supraventricular tachycardia is usually treated if:
- You have symptoms such as dizziness, chest
pain, or fainting (syncope) that are caused by your fast heart
rate.
- Your episodes of fast heart rate are occurring more
frequently or do not revert to normal on their own.
Treatment for sudden-onset (acute) episodes
When
episodes of
supraventricular tachycardia (SVT) start suddenly and
cause symptoms, you can try
vagal maneuvers—such as gagging, holding your breath and bearing down (Valsalva maneuver), immersing your face in ice-cold
water (diving reflex), coughing, or putting pressure on your eyelids. These
simple maneuvers stimulate the vagus nerve, which can slow conduction of
electrical impulses that control your heart rate. Your doctor will teach you
how to perform vagal maneuvers safely.
Your doctor may also
prescribe a short-acting medicine that you can take by mouth if vagal maneuvers
don't work. This allows some people to manage their SVT without having to visit
the emergency room repeatedly.
If your heart rate cannot be slowed
using vagal maneuvers, you may have to go to your doctor's office or the
emergency room, where a fast-acting medicine such as adenosine or verapamil can
be given. If the arrhythmia does not stop and symptoms are severe,
electrical cardioversion, which uses an electrical
current to reset the heart rhythm, may be needed.
Ongoing treatment of recurring supraventricular tachycardia
If you have recurring episodes of
supraventricular tachycardia, you may need to take
medicines, either on an as-needed basis or daily. Medicine treatment typically
includes
beta-blockers,
calcium channel blockers, other
antiarrhythmic medicines, or
digoxin. In people with frequent episodes, treatment
with medicines can decrease recurrences. But these medicines may have side
effects.
Many people with supraventricular tachycardia have a
procedure called
catheter ablation, which blocks abnormal electric
impulses and can eliminate supraventricular tachycardia and the need to take
medicines. But this procedure has risks, including infection, bleeding, and
injury to the heart. If your heart is injured during catheter ablation, you
will need a pacemaker. You must balance your feelings about taking medicine for
the rest of your life with having an invasive procedure. Also, catheter
ablation is not available everywhere and is best performed in a medical center
that has staff experienced with this complicated procedure.
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Heart problems: Should I have catheter ablation?
Treatment for atrioventricular nodal reentrant tachycardia (AVNRT)
In the case of
atrioventricular nodal reentrant tachycardia (AVNRT),
medicines can be taken—either daily or only when the fast heartbeat arises—or
catheter ablation may be done.
If you have infrequent episodes of
AVNRT that last hours but do not cause severe symptoms, your doctor may
recommend that you take medicines only when you have an episode. These
medicines include
antiarrhythmic medicines,
calcium channel blockers, and
beta-blockers.
Your doctors may recommend
daily doses of calcium channel blockers, beta-blockers, and/or digoxin if you
have frequent episodes of AVNRT. If these medicines are not effective in
stopping
supraventricular tachycardia from recurring, your
doctor may recommend that you take an antiarrhythmic medicine.
If
you take daily medicine for AVNRT or you have significant symptoms, you may
want to consider having
catheter ablation.
-
Heart problems: Should I have catheter ablation?
Treatment for atrioventricular reciprocating tachycardia (AVRT)
In the case of
atrioventricular reciprocating tachycardia (AVRT), you
can take medicines for recurrent episodes either on an as-needed or daily
basis, depending on how frequently they occur. These medicines—which include
beta-blockers,
calcium channel blockers, and
digoxin—are often effective in stopping or preventing
episodes of AVRT.
But in some people with a type of AVRT called
Wolff-Parkinson-White (WPW) syndrome, digoxin and
verapamil may result in extremely fast heart rates that can lead to
lightheadedness, fainting (syncope), and even death. These drugs are only
dangerous when given in an emergency when someone with Wolff-Parkinson-White
syndrome is having
atrial fibrillation.
Treatment of WPW
frequently requires
antiarrhythmic medicines, such as propafenone
(Rythmol) or flecainide (Tambocor), that slow electrical conduction over the
extra connection.
Catheter ablation is often recommended
for people with WPW, especially those who have severe symptoms or also have
atrial fibrillation or flutter. This procedure can
successfully eliminate WPW most of the time. There is a small risk of the
arrhythmia recurring even after successful ablation of WPW. But a second
session of catheter ablation is usually successful.
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Heart problems: Should I have catheter ablation?
Ongoing Concerns
Symptoms of
atrioventricular reciprocating tachycardia (AVRT),
including
Wolff-Parkinson-White (WPW) syndrome, usually start
during the teen or young adult years. Episodes of WPW can trigger a
life-threatening heart rhythm called ventricular fibrillation, although this is
extremely rare. Your doctor may recommend that you wear a medical bracelet to
alert medical professionals of your condition if you are at risk for
ventricular fibrillation.
AV nodal reentrant tachycardia (AVNRT)
usually first causes symptoms from the teen years to middle age.
After episodes of
supraventricular tachycardia begin, they generally
recur. These arrhythmias frequently stop spontaneously or with simple
maneuvers, but you may have to take medicines daily if the arrhythmias keep
happening. Medicine treatment typically includes
beta-blockers,
calcium channel blockers, or
digoxin. In people with frequent episodes, treatment
with an
antiarrhythmic medicine can decrease recurrences, and
catheter ablation can eliminate the arrhythmia
altogether.
When supraventricular tachycardia occurs in someone
with significant
coronary artery disease, the heart may not receive
enough blood to keep up with the demands of the increased heart rate. If this
occurs, the heart may not get enough oxygen, potentially causing chest pain
(angina) or a
heart attack. If tachycardia is left untreated,
repeated and long episodes of tachycardia can lead to
heart failure. But mild supraventricular tachycardia,
with rare and short episodes, does not typically lead to heart failure.
Prevention
You can reduce your risk of having
episodes of
supraventricular tachycardia by avoiding certain
stimulants or stressors, such as caffeine, nicotine, some medicines (for
example, decongestants), illegal drugs (stimulants, like methamphetamines and
cocaine), excess alcohol, lack of sleep, and overeating.
If fast
heart rates continue, long-term medicines such as beta-blockers may be used to
help prevent a recurrence of the fast heart rate.
Living With Tachycardia
Home care includes
monitoring your
supraventricular tachycardia and trying to slow your
heart when a fast heart rate occurs. To monitor your condition, you may find it
helpful to keep a
diary of your heart rate and your symptoms.
Check your pulse when you have symptoms and record the
information in your diary. Be aware that if your heart is beating rapidly, it
may be difficult to feel your pulse and get an accurate count of your actual
heart rate.
By keeping a diary of your heart rate and symptoms,
you may be able to identify stressors—such as lack of sleep, drinking alcohol,
or overeating—that trigger episodes.
Also, it's usually important
to avoid overuse of caffeine, nicotine, or alcohol and the use of illegal
drugs, such as stimulants like cocaine, ecstasy, or methamphetamine. For people
who are especially sensitive, even decaffeinated teas or coffee can cause
supraventricular tachycardia episodes.
Decongestants that contain
stimulants should also be avoided, including oxymetazoline (such as Afrin and
other brands) and pseudoephedrine (such as Sudafed and other brands). Doctors
also warn against using diet pills or "pep" pills (because many contain
caffeine), ephedrine, ephedra, the herb ma huang, or other stimulants.
Your doctor may suggest that you try
vagal maneuvers—such as gagging, holding your breath and bearing down, or
immersing your face in cold water—to slow your heart rate. Your doctor will
help you learn these procedures so you can try them at home when your fast
heart rate occurs.
Medications
If you have symptoms, medicines may be
used to treat
supraventricular tachycardia.
Medication Choices
For severe symptoms, such as
chest pain, shortness of breath, or feeling faint, you may be given fast-acting
antiarrhythmic medicines by health professionals in
the hospital emergency department, where your heart can be monitored.
Fast-acting antiarrhythmic medicines commonly used to slow the heart rate
during an episode include:
Long-term use of an antiarrhythmic medicine may also be
needed to reduce the chance of having more episodes of supraventricular
tachycardia or to reduce the heart rate during these episodes. Common medicines
used for this purpose include:
What to Think About
All medicines have side
effects. See a
table of medicines that may interact with other
medicines and with
pacemakers and
implantable cardioverter defibrillators (ICDs).
Surgery
Open-heart surgery for
supraventricular tachycardia is performed rarely and
is usually done only if surgery to remove abnormal electrical pathways (catheter ablation) or other treatments cannot be used. If you have heart surgery
for another heart condition, catheter ablation may be done at the same
time.
Other Treatment
An electric shock to the heart
(electrical cardioversion) may be necessary if you are having severe symptoms
of
supraventricular tachycardia and your heart rate does
not return to normal using
vagal maneuvers or fast-acting medicines.
If you continue to have
episodes that cause serious symptoms, a procedure called catheter ablation may
be done during an
electrophysiology (EP) study. During an EP study, the
extra electrical pathway or cells in the heart that are causing the fast heart
rate can often be identified and destroyed using catheter ablation.
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Heart problems: Should I have catheter ablation?
If you have tried other treatment, such as medicine and catheter
ablation, but still have tachycardia, a
pacemaker might be an option.
Other Treatment Choices
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Electrical cardioversion
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Catheter ablation
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Pacemaker
What to think about
Electrical cardioversion is
only used in an emergency. If you are awake, medicines will be used to control
pain and make you sleepy during the procedure.
Catheter ablation is
effective for people with severely symptomatic supraventricular tachycardia due
to AV nodal reentrant tachycardia or a concealed bypass tract. It can also
reduce medical costs when compared with commonly used drug therapies.
Catheter ablation has risks, but they are rare. You must balance your
feelings about taking medicine for the rest of your life with having an
invasive procedure.
A pacemaker might be an option for some
people. Your doctor may suggest a pacemaker if you have symptoms and if
medicine or catheter ablation have not worked for you.
Other Places To Get Help
Organizations
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National Heart, Lung, and Blood Institute
(NHLBI)
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| P.O. Box 30105 |
| Bethesda, MD 20824-0105 |
| Phone: |
(301) 592-8573 |
| Fax: |
(240) 629-3246 |
| TDD: |
(240) 629-3255 |
| E-mail: |
nhlbiinfo@nhlbi.nih.gov |
| Web Address: |
www.nhlbi.nih.gov |
| |
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The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:
- Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
- Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
- Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
|
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Related Information
References
Other Works Consulted
-
Calkins H (2008). Supraventricular tachycardia: AV
nodal reentry and Wolff-Parkinson-White syndrome. In V Fuster et al., eds.,
Hurst's The Heart, 12th ed., pp. 983–1002. New York:
McGraw-Hill Medical.
-
Drugs for cardiac arrhythmias (2007). Treatment Guidelines From The Medical Letter, 5(58): 51–58.
-
Epstein AE, et al. (2008). ACC/AHA/HRS 2008 Guidelines
for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the
American College of Cardiology/American Heart Association Task Force on
Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002
Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia
Devices): Developed in Collaboration With the American Association for Thoracic
Surgery and Society of Thoracic Surgeons. Circulation,
117(21): e350–e408.
-
Olgin JE, Zipes DP (2008). Specific arrhythmias:
Diagnosis and treatment. In P Libby et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed., volume 1,
pp. 863–931. Philadelphia: Saunders Elsevier.
-
U.S. Food and Drug Administration (2005). 2005 safety
alert: Cordarone (amiodarone HCl). FDA Med Watch.
Available online:
http://www.fda.gov/medwatch/SAFETY/2005/cordarone_DHCP.htm.
-
Zipes DP, et al. (2006). ACC/AHA/ESC 2006 Guidelines
for Management of Patients With Ventricular Arrhythmias and the Prevention of
Sudden Cardiac Death: A Report of the American College of Cardiology/American
Heart Association Task Force and the European Society of Cardiology Committee
for Practice Guidelines (Writing Committee to Develop Guidelines for Management
of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac
Death). Circulation, 114(10): 1088–1032.
Credits
|
Author
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Robin Parks, MS |
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Editor
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Kathleen M. Ariss, MS |
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Associate Editor
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Pat Truman, MATC |
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Primary Medical Reviewer
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Caroline S. Rhoads, MD - Internal Medicine |
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Specialist Medical Reviewer
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Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology |
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Last Updated
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September 17, 2008 |
