Paroxysmal supraventricular tachycardia (PSVT)

Causes

Normally, the chambers of the heart (atria and ventricles) contract in a coordinated manner.

• The contractions are caused by an electrical signal that begins in an area of the heart called the sinoatrial node (also called the sinus node or SA node).
• The signal moves through the upper heart chambers (the atria) and tells the atria to contract.
• After this, the signal moves down in the heart and tells the lower chambers (the ventricles) to contract.

The rapid heart rate from PSVT may start with events that take place in many different areas above the lower heart chambers (ventricles).

PSVT can occur with digitalis toxicity and with conditions such as Wolff-Parkinson-White syndrome.

The condition occurs most often in young people and infants.

The following increase your risk for PSVT:

• Alcohol use
• Caffeine use
• Illicit drug use
• Smoking

Symptoms

Symptoms usually start and stop suddenly, and can last for a few minutes or several hours. They can include:

• Anxiety
• Chest tightness
• Palpitations (a sensation of feeling the heart beat), often with an irregular or fast rate (racing)
• Rapid pulse
• Shortness of breath

Other symptoms that can occur with this condition:

• Dizziness
• Fainting

Exams and Tests

A physical examination during a PSVT episode will show a rapid heart rate. It may also show bounding pulses in the neck.

The heart rate may be over 100, and even more than 250 beats per minute (bpm). In children, the heart rate tends to be very high. There may be signs of poor blood circulation such as light-headedness. Between episodes of PSVT, the heart rate is normal (60 to 100 bpm).

An ECG during symptoms shows PSVT. An electrophysiology study (EPS) may be needed for an accurate diagnosis and to recommend the best treatment.

Because PSVT comes and goes, to diagnose it patients may need to wear a 24-hour Holter monitor. For longer periods of time, another tape of the rhythm recording device may be used.

Treatment

If you do not have symptoms or any other heart condition, PSVT may not need treatment.

If you have an episode of PSVT, there are techniques you can try on your own to interrupt the fast heartbeat.

• One is called the Valsalva maneuver. To do this, you hold your breath and strain, as if you were trying to have a bowel movement.
• Another technique you can try is to cough while sitting with your upper body bent forward.
• Some people find that splashing ice water on the face is helpful.

You should avoid smoking, caffeine, alcohol, and illicit drugs.

Emergency treatment to slow the heartbeat back to normal may include:

• Electrical cardioversion, the use of electric shock
• Medicines through a vein

Long-term treatment for people who have repeat episodes of PSVT, or who also have heart disease, may include:

• Cardiac ablation -- a procedure used to destroy small areas in your heart that may be causing the rapid heartbeat (currently the treatment of choice for most PSVTs)
• Daily medications to prevent repeat episodes
• Pacemakers to override the fast heartbeat (on occasion may be used in children with PSVT who have not responded to any other treatment)
• Surgery to change the pathways in the heart that send electrical signals (this may be recommended in some cases for people who need other heart surgery)

Outlook (Prognosis)

PSVT is generally not life threatening. If other heart disorders are present, it can lead to congestive heart failure or angina.

When to Contact a Medical Professional

Call your health care provider if:

• You often have a sensation of feeling the heart beat quickly and symptoms do not end on their own in a few minutes
• You have a history of PSVT and an episode does not go away with the Valsalva maneuver or by coughing, or other symptoms occur with the rapid heart rate
• Symptoms return often
• New symptoms develop

Alternative Names

PSVT; Supraventricular tachycardia

References

Olgin JE, Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. St. Louis, Mo: WB Saunders; 2011:chap 39.

Zimetbaum P. Cardiac arrhythmia with supraventricular origin. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 64.

Update Date: 6/18/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.