SVT questions for cardiologist

I was prescribed metropolol for AFib but couldn’t tolerate. My sleeping HR is in the high 40s and dipped into low 40s with it.

I, too, would be concerned for you in the way you describe your circumstances. Metoprolol is a good and safe drug in the right body for it. Worked for me until they kept upping the doses in the few months prior to my first ablation. The only symptom I had was syncope when rising to my feet from seated one day, the only time that happened, but I also found that during the day I would feel a heavy tingling at the back of my neck and up into the scalp. I didn't feel faint, nor did my vision begin to close in on me, but this happened at 60 mph................with me doing the driving..!!

Unfortunately, the only practical way to rule out your fears is to experiment. If you cardiologist would agree to it (so he/she feels sanguine about keeping you as a patient...), maybe you could try half a dose of what he would otherwise prescribe for a month, and then double it for a month to see what effect each has on you. So, half dose, then up to his originally prescribed dose.

I have near syncope episodes as well out of nowhere. My cardiologist didn't seem concerned about it but having that happen while driving was terrifying for me. I only got the appointment for the EP after insisting that it was not anxiety and that something else was going on. My visit with the EP ended up being with the RNP because the same day he broke his wrist and was in surgery. She did prescribe me verapamil to see if it would help until my procedure which won't take place for 6-8 weeks. I will start the verapamil in the place of my blood pressure med I was on. My heart rate usually rises to 160's and unfortunately last much longer than 30 seconds. More like 5 to 15 minutes st times. Through this forum I have learned about the modified valsalva maneuver and will try it with my next occurrence. Hope you get the answers you need.

Same here!! I’m currently awaiting a cardiology consult at Mayo. My current cardiologist loves to say “Benign” and then said “I don’t think your SVT is causing your presyncope”. SO frustrating-the only time I start to faint is when I feel my heart beat flutter in my neck and then it beats really fast for usually less than 20 seconds. I was only able to catch the SVT on my Apple Watch once. It happened 19 times during a 30 day event monitor. All of my episodes have been short SVT, thankfully.

I just want to be taken seriously and get it under control so I can drive again. I have a relatively healthy heart, and I am very thankful for that.
This SVT can’t be good for keeping it healthy though. My heart is working twice as hard during these episodes.

Metoprolol seemed to help at first, but after 30 days of it I had my worst episode yet, leaving me seriously confused about where I was, etc.

What brought me to Mayo was a wonderful neurology consult because my current cardiologist had said it was not my heart causing the SVT. Further testing did show some autonomic dysfunction, but no POTS or Orthostatic Hypotension.

@beanyh Your SVT is short-lived and occasional. Yeah, it's not 'good' to have any arrhythmia, any kind at all, but since yours is 'paroxysmal', it is the best place to be if you must have any one of the 16 or so arrhythmias. It's occasional and self-limiting nature, even if just for the time being, is not going to put you in any danger, nor is it going to cause permanent remodeling of your heart's structures.

What you DO want to do is to push for close monitoring, for your EP/cardio team to accept data uploads from you if you have a wearable or Kardia 6L that can show them what you record when you know you're having an episode, and you want a short line to get an ablation if that is a likely restorative procedure for your arrhythmia.

I'd second gloaming on the monitoring of your SVTs over time, if they continue and you're symptomatic when they occur. I've had quite a significant number of SVTs, A-fib and A-flutter over the years, they're for the most part short-lived, lasting for a few seconds to maybe a minute or two. Some have lasted longer, for several hours.

You'd think that if your episodes are that short-lived, it might not be long enough to develop the symptoms that may be associated with SVTs, but I can tell you that in my own experience, I've had mild shortness of breath, and felt light-headed, these symptoms come on with the onset of the SVT, and last for as long as the SVT does. The symptoms disappear when the SVT disappears. That's always puzzled me, as I'd have thought that the onset of these symptoms would come on after some time after the SVT started, after it had gone on long enough to affect the perfusion of blood to the brain and other organs. But that has not been my experience, although the SOB and light-headedness I feel are mild. I've never actually passed out from these episodes, though I did have a bradycardia episode ( heart-rate in the high 30's) one time before I got my pacemaker where I did pass out. But that's another whole thing.

@gloaming and @marybird , thank you both for taking the time to respond! Your input is both helpful and reassuring to me ❤️