Patient Journey: PSVT Strikes Anytime, Anyplace

Released October 2023

Transcript

Jessica  0:16  

Hi, Kathy. So I have had some issues. I've been experiencing some shortness of breath associated with a fast heart rate. It feels like my heart seems to beat out of my chest, I get this really high heart rate, it feels like my heart's almost in my throat. It makes me feel like I'm having a panic attack or an anxiety attack. It makes me feel short of breath. It makes my hands shake. And it makes me feel dizzy sometimes.

Cathy  0:43  

Now, did you go into the hospital or the emergency room when you were feeling this way? So they could assess what was going on with you?

Jessica  0:51  

I did. I've actually been to the emergency room a couple times with this same problem.

Cathy  0:57  

And what did they tell you they thought was happening?

Jessica  1:01  

So each time I've been to the emergency room, they've diagnosed me with what they call PSVT or SVT..

Cathy  1:09  

Okay, which is paroxysmal supraventricular tachycardia. So basically, they're saying that for some unauthorized reason, your heart is beating a lot faster than it's supposed to. And maybe even giving you two or three different beats at the same time, that are like racing and uncontrollable.  Would you kind of say that that would pinpoint what's going on? 

Jessica 1:33

Yes, I would. 

Cathay 1:34

Okay, what do they do for you?

Jessica  1:36  

So a couple different things. When I first went to the emergency room, they tried some conservative measures. They would have me cough, and bear down, which is a valsalva maneuver to try and get a heart rate to break to be back into a normal sinus rhythm, which is a much lower heart rate. And when those things didn't work, then we had to try some different measures with some different medications.

Cathy  2:02  

Now I know, one thing that makes this extremely difficult for you is because of your area of expertise. Aren't you a nurse and a cardiology nurse as well,

Jessica  2:11  

I am. I've been a nurse for almost 15 years. And my background is cardiology for those 15 years. So I actually work on a telemetry unit where I take care of patients much like myself who have different arrhythmias, like SVT, afib, patients who have had heart attacks, open heart surgery, valve replacements. So it really hits home for me,

Cathy  2:35  

As we talk about this, I'm trying to do some more research and study what we can do to help patients like you who are feeling this way, as far as our treatment modalities. Now, aside from doing an EKG and telling you to do the valsalva maneuver, what else did they tell you in the emergency room? Or what other medications did they use to try to stop your heart from beating so fast?

Jessica  3:01  

So when I was in the emergency room and had the high heart rates that would not break and were not responsive to coughing or doing the valsalva maneuver where you bear down, I was given adenosine, which is a medication in your IV that tries to help reset the heart back into a normal sinus rhythm.

Cathy  3:18  

Okay, now, you know a little bit about this medicine. But I'll tell you, giving it and experiencing it are two totally different things. You were aware that it was going to stop your heart from beating and restart your heart, or were you not?

Jessica  3:35  

I was aware, and the nurses still explained that to me, just like I explain it to my patients when I've given it. But having that feeling yourselfl is completely different.

Cathy  3:46  

I can't imagine. Did you feel like you were blacking out, you were passing out? Or tell me exactly how you felt. Because for people who don't know, when adenosine is given, it completely disrupts the heartbeat, it stops your heart. It's just like someone in cardiac arrest for those few moments. And even though it's only a moment, it seems like it's forever.

Jessica  4:07  

So I remember the nurse pushing the medication. And it was a few seconds. And I remember it taking my breath away. And I just thought, oh my goodness, I'm either gonna pass out or my heart's gonna start back, and I don't know which is gonna happen first. And I know as a nurse, you know, when my patient has that sensation, I kind of hold my breath with them, you know, thinking the same thing they're gonna pass out or their heart's gonna start back. But being the one in the bed, it's very scary, even when you know what's coming.

Cathy  4:36  

Did you ever have an echocardiogram?

Jessica  4:38  

I did. They scheduled me for an echo at a later date, not the same time that I was in the office. Just to check, you know, my wall motion, my ejection fraction and make sure there weren't any abnormalities in my heart that would cause the SVT.

Cathy  4:56  

So after that, did they say, “we're going to keep you on this metoprolol forever? Or did they say we're going to do an ablation? Or just what other advice… did they send you to an electrophysiologist that just kind of monitors your heart rhythms and does a little bit more about looking at your heart anatomy?

Jessica  5:16  

So the original plan was to start me on the beta blocker and see I did. And I was pretty young when I was diagnosed with SVT. I was actually 18 and in nursing school, but I was unable to tolerate the beta blocker. My blood pressure and heart rate when I didn't have episodes of SVT was pretty low. So in taking the medication, it dropped my blood pressure even lower, and it made me feel terrible. And it kept my heart rate in the 50s and low 60s. So I did not feel good at all on the medication.

Cathy  5:48  

Did you ever end up with an ablation? Or did this just go away?

Jessica  5:52  

So I went to see an electrophysiologist. And they actually, the first one suggested that I have an ablation. And I actually got a second opinion, just again, because of my age, just to see if that's really something that both of them felt necessary. Because I had done some research and being in nursing school, I just knew that there were various options, you know, for treatment, or SVT PSVT. And the second electrophysiologist thought that it was reasonable to wait and try to control some of the episodes with things like changing my diet up, trying to control stress, and looking at my exercise regimen. At the time, I was running almost five miles a day, and try to, you know, control with some, I guess, more natural ways rather than jumping straight to the ablation with my age.

Cathy  6:43  

So did you slow down your running?

Jessica  6:45  

I did, I slowed down. I changed up some things and it seemed to help, you know, put a greater distance between the times of the episodes. 

Cathy  6:54  

So tell me, did we ever get to an ablation or no?

Jessica  6:58  

So no, I never did an ablation. My episodes were fewer and farther between, which is great news. And it did enable me to not have to take medication every day, which was even better news because my blood pressure and heart rate normally don't tolerate beta blockers, calcium channel blockers, anything that they tried me on. So what I actually do now is a method called “pill in a pocket.” So I carry Cardizem 360 milligrams. And I carry that with me everywhere I go. And I only take it if I need it, if I have a breakthrough episode.

Cathy  7:33  

Now if you do have a breakthrough episode, how long does it take the Cardizem to work? Do you put it under your tongue? Do you just take it in, it goes through your system and takes a half hour or so to work. Explain that to me. I just need a little more clarification.

Jessica  7:48  

I usually have a couple minutes where I know something's happening, I'm probably going to have an episode. So if I have that feeling, I usually go ahead and take the Cardizem.  I swallow the capsule whole like I would, you know, Tylenol or any other pill. And it does take about 30 minutes before it takes effect. So if I do still have an episode, so to speak, I feel my heart rate go very fast, I get that kind of anxiety feeling, sometimes the shortness of breath, my hands might shake. But usually that Cardizem does break my episode. I may feel the effects, for you know, up to an hour. But it has kept me out of the emergency room.

Cathy  8:27  

Well, I'm grateful that you had success, not so grateful that you had to go through all of the challenges that you did, but I'm very, very glad you've had success. So as you're working on the cardiac unit as a nurse, when there is a code blue or rapid response, or whatever your institution might call it, and you have to respond to a patient’s side, does that send you often to SVT as well? Or how are you handling that?

Jessica  8:58  

It doesn't, or you know, it hasn't yet in the last 15 years anyway. I think I've had to learn how to control your stress. Learn how to leave work at work, and not take that home with you, as hard as that, you know, may sound, and learn what works for you. So there are different triggers for everybody. You know, some folks, you know, maybe it is, you know, that fourth cup of coffee or that second soft drink of the day. Some people don't know what their triggers are, it just happens. But for me even being in those stressful situations, it's learning how to control that, how to de-stress after their situations, and learning how to leave that stressful situation and be able to kind of compartmentalize that in my mind so that I don't carry it with me. And it doesn't become a burden that can send me into an episode of SVT.

Cathy  9:52  

Well I'll have to tell you, you have learned a lot and you have been very successful on your self- care and self-care is so important for nurses, because we spend our lifetime taking care of others. And we spend a small fraction of it taking care of ourselves. So as you de-stress and you start to eat right, and not run five miles a day, mind you, it seems like you have found the plan to help you be successful in your normal daily life. 

One of the other things I think is so important is you can share with your patients that you understand what is happening to them, and they're not going through this alone and that you're there by their side to help them and to educate them. So I truly thank you for that. Thank you for the time that you spent with me today. Feel free to call me if there's anything else you'd like to discuss.

Jessica  10:59  

Thank you for taking the time to speak with me as well. I have enjoyed it. 

Cathy 11:04

You have an awesome day. Bye bye now. 

Jessica 11:07

Thank you. Bye.

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