Paroxysmal Supraventricular Tachycardia (PSVT)

What is paroxysmal supraventricular tachycardia?

Paroxysmal supraventricular tachycardia (PSVT) is a general term used to describe a type of arrhythmia (irregular heartbeat). Tachycardias are faster-than-normal heartbeats. If you have this condition, your heart may suddenly beat more quickly. Just as suddenly, your heart may slow down and beat at a normal rate. These episodes (also called paroxysms) are triggered by rapid heartbeats originating from the top chambers of your heart called the atria. The two bottom chambers are the ventricles. These four chambers work together to pump blood through your heart and to the rest of your body.

PSVT results from abnormal electrical activity that begins in the atria. This abnormal activity causes the atria to contract (pump) very quickly over and over again. Treatment for PSVT isn’t always required, and the condition isn’t usually life threatening. If necessary, providers can treat this condition with medications, cardiac procedures and rarely a pacemaker implant. See your provider for an evaluation if you notice any irregularities in your heartbeat.

How does a normal heartbeat happen?

In a heart that works normally, the heartbeat begins in the sinoatrial node (SA node). The SA node is a small mass of tissue in the atria. It serves as the heart’s pacemaker.

The SA node sends electrical signals that cause the atria to contract (pump). The signals travel to the ventricles through the atrioventricular node (AV node), which is a little clump of cells in the middle of the heart. The AV node carries the electrical impulses that tell the ventricles to contract.

What are the types of paroxysmal supraventricular tachycardias?

A variety of conditions are considered PSVT. These can be caused by multiple connections from the top to the bottom chambers of your heart either directly or through the AV node, resulting in tachycardia. In other circumstances, an irritable focus in the top chambers of your heart could also trigger tachycardia.

Common names of these tachycardias include:

• Atrioventricular nodal re-entrant tachycardia (AVNRT).
• Orthodromic reciprocating tachycardia (ORT).
• Antidromic reciprocating tachycardia.
• Atrial tachycardia.
• Atrial flutter.

How common is PSVT?

Heart arrhythmias are very common. Millions of people in the United States live with some type of arrhythmia.

Supraventricular tachycardias are the most common type of arrhythmias in children and babies. They’re more common among children who have heart disease.

What causes paroxysmal supraventricular tachycardia?

PSVT (also called re-entry tachycardia) is a type of atrial arrhythmia. It happens when there is abnormal electrical activity in the atria. This is caused by an abnormally irritable area in the atria or by a short circuit in your heart causing electrical signals to travel around and around in a circular pattern. This causes the atria to contract quickly over and over again.

These abnormal electrical signals can happen when there is an extra pathway between the atria and the ventricles either directly or within the AV node. People with a condition called Wolff-Parkinson-White syndrome have this extra pathway in their heart. If electrical signals travel more quickly through the extra (accessory) pathway than they do through the AV node, your heart beats faster than it should.

Like other types of arrhythmias, PSVT can be inherited (passed down through families). It can also develop as a result of:

• Age.
• Anemia.
• Dehydration and fatigue.
• Ingesting drinks and foods that contain caffeine. Foods that have a lot of fat, sugar or carbohydrates can cause heart palpitations after eating.
• Drugs such as nasal decongestants containing pseudoephedrine.
• Excessive alcohol.
• Heart attack or damage from a previous heart attack or heart surgery.
• Heart disease, including coronary artery disease (CAD).
• High blood pressure (hypertension).
• High stress levels and high anxiety levels.
• Hormonal changes, such as those that happen during menopause or pregnancy. Heart palpitations during pregnancy are very common.
• Obesity and carrying extra weight.
• Smoking and using tobacco products.
• Structural heart problems, including heart valve disease.
• Thyroid problems, including hyperthyroidism.

What are the symptoms of paroxysmal supraventricular tachycardia?

Symptoms of PSVT usually start and stop abruptly. They range from mild to severe. You may feel your heart beating quickly after exercise, when you haven’t gotten enough sleep or if you’re under a lot of stress. Symptoms include:

• A fast, regular heart rate. It’s usually over 100 beats per minute (BPM), but it can be as high as 250 beats per minute. Children with PSVT usually have a higher heart rate.
• Fluttering or pounding in your chest, throat or neck (heart palpitations). You may feel a strong or forceful pulse.
• Sudden changes in heart rate. Your heart might beat quickly for a few minutes or a few hours and then abruptly begin to beat normally again. A normal heart rate for adults is between 60 and 100 beats per minute (BPM).

When you have a PSVT episode, you may also experience:

• Anxiety and confusion.
• Chest pain, discomfort or tightness in the chest.
• Difficulty breathing or shortness of breath (dyspnea).
• Dizziness and lightheadedness.
• Fainting (syncope) or loss of consciousness.
• Fatigue or exhaustion.
• Nausea.

How is PSVT diagnosed?

After asking about your symptoms and listening to your heart, your provider will recommend a blood test. This test looks for problems with your thyroid and other problems in your blood.

Your provider will do a test called an electrocardiogram (EKG or ECG). You get this test in your provider’s office and it takes about 15 minutes. An EKG monitors your heart rate using sensors that attach to your skin. Your provider may also recommend an exercise stress test if strenuous activity triggers an episode of PSVT.

If the EKG doesn’t detect an irregular heartbeat, your provider may recommend an ambulatory monitor such as a Holter monitor or a patch monitor for a more extended duration. You wear this portable device for at least two days but up to a month. It records your heart rate and any irregular heartbeats.

How do providers treat paroxysmal supraventricular tachycardia?

Depending on your overall health and symptoms, you may not need treatment. If you have an arrhythmia, you’ll see a special type of heart doctor called a cardiologist. They may recommend you:

• Avoid alcohol and caffeine. You may also need to stay away from some types of medications like nasal decongestants that include pseudoephedrine.
• Change your sleeping habits to get more rest.
• Drink plenty of water to avoid getting dehydrated.
• Get help for anxiety and do relaxation exercises to lower your stress levels.
• Lose weight and maintain a healthy weight (if you are obese).
• Quit smokingand/or using tobacco products.

You can also ask your provider about ways to temporarily slow down your heart rate if you’re having an episode. These include:

• Vagal maneuvers, which includeseveral techniques such as splashing cold water on your face, coughing in a certain way and gently pressing on your eyeballs while you close your eyes. Ask your provider about these maneuvers. You should not attempt to do them on your own without training.
• Valsalva maneuver, a type of vagal maneuver that can slow your heart rate for a little while. To do this, you take a breath, pinch your nose and bear down (like you’re having a bowel movement). Then, breathe out forcefully like you’re blowing up a balloon.
• If changes in your heartbeat happen often, they’re causing distress or you have other heart conditions, your provider may recommend treatments. These include:
• Catheter ablation, a minimally invasive procedure that damages a bit of the tissue that’s sending irregular electrical signals from your heart and causing the arrhythmia.
• Carotid sinus massage, a type of massage that uses gentle pressure on your neck to help your body slow your heart rate. Your provider does this massage — you shouldn’t try it at home.
• Devices, such as an implantable cardioverter defibrillator (ICD), subcutaneous ICD or a permanent pacemaker.
• Electrical cardioversion, a procedure that delivers safe jolts of energy to your heart. The energy disrupts the abnormal rhythm and helps your heart beat at a normal pace.
• Medications, including arrhythmia medications to make your heart rhythm regular. These medications can also prevent heartbeat irregularities.

How can I reduce my risk of PSVT?

You may not be able to avoid PSVT. But you can lower your risk by making smart lifestyle choices and staying healthy. To lower your risk, you should:

• Follow a heart-healthy diet.
• Avoid triggers that you know bring up the episodes of PSVT.
• Get plenty of exercise, stay active and try to stay physically fit.
• Lose weight if you need to and talk to your provider about maintaining a healthy weight.
• Lower your blood pressure if you have hypertension.
• Maintain healthy cholesterol levels.
• Quit smoking and/or using tobacco products.
• If you or your child has a heart condition that increases your risk of PSVT, talk to your provider. They’ll give you specific information about how to stay healthy and lower your risk of heart problems.

What can I expect if I have PSVT?

The outlook for people with PSVT depends on several factors, including your age and your overall health. You may be able to relieve symptoms with lifestyle and dietary changes.

Over time, PSVT can weaken your heart muscle. In severe cases, PSVT can lead to loss of consciousness, and it can even cause sudden cardiac arrest. If you have PSVT, see your provider regularly so they can monitor your heart health. In almost all circumstances, PSVT can be cured with catheter ablation.

When should I see my healthcare provider about PSVT?

If you have any concerns about your heartbeat or you have symptoms of arrhythmia, talk to your provider. If you have PSVT, it’s very important to see your cardiologist regularly.

Seek medical help right away if you:

• Experience sudden or unexplained exhaustion.
• Feel faint or you pass out.
• Have chest pain, shortness of breath or trouble breathing.

A note from Cleveland Clinic

A paroxysmal supraventricular tachycardia episode can be scary. But this condition isn’t usually dangerous or life-threatening. You should see your provider for an evaluation if you have any concerns about your heartbeat. It’s always a good idea to get a full evaluation so your provider can rule out a serious health problem. Although you may not need treatments for PSVT, they’re available if you do. By staying active, avoiding caffeine and alcohol, making healthy choices and seeing your cardiologist regularly, you can reduce your risk of complications from PSVT.