Paroxysmal supraventricular tachycardia: causes, symptoms, treatments


Listen to your heart is one of his most famous songs Laura Pausini. Who knows if, every time she sings it, her thoughts really go to her heart muscle, which sometimes acts crazy: in a recent interview, in fact, the singer revealed that she suffers from paroxysmal supraventricular tachycardia (often shortened to Tpsv), a special form of arrhythmia with which the artist has lived since she was a child. It was precisely this racing heartbeat that kept her off the stage for around twenty minutes during the final night of the Eurovision Song Contest 2022, when false rumors of an alleged argument with the other two hosts had circulated. “Every once in a while, I feel like my heart is coming out of my body,” Pausini told Mara Venier during an episode of “Domenica In.”

What is Paroxysmal Supraventricular Tachycardia?

“By definition, we are talking about tachycardia when heart rate exceeds 100 beats per minute“, she emphasizes Dr Fabrizio Hugo, cardiologist, master in Sports Cardiology and head of Hemodynamics at Sant’Andrea Hospital in Vercelli. “Exceeding this limit It does not necessarily indicate a problem. For example, it is normal for the heart rate to accelerate in case of physical exertion, strong emotion, fever or other external inputs: these conditions may cause a temporary increase in heart rate, which then returns to normal limits, generally between 60 and 90-100 beats per minute.’

All normal heart accelerations fall into the normal heart rhythm, which is defined as sinus because the sinus node (a small “electrical control unit” located in the right atrium) acts as a natural pacemaker, capable of stimulating regular and rhythmic beats. In the paroxysmal supraventricular tachycardia, on the other hand the tachycardia is inappropriate, i.e. it is not justified by external stimuli. “The term ‘paroxysmal’ suggests exactly his abrupt, sudden onsettypically at rest and in calm conditions, which fortunately subsides spontaneously”, explains Dr. Ugo.

What are the causes of paroxysmal supraventricular tachycardia?

In the Tpsv episodes, he is no longer the hub sinus to dictate the heart’s rhythm, because a kind of “short circuit” is created due to one more cardiac muscle fiber than normal, which conducts electrical impulse from the atria to the ventricles and vice versa, interfering with normal conduction pathways.

“The reason why this ‘excess fiber’ is activated is not yet completely clear,” admits Dr. Ugo. “The fact that paroxysmal supraventricular tachycardia occurs often in youth can lead to bonding with friends hormones, so much so that many cases resolve on their own after puberty. In other cases, however, TPSV begins at age 20-30, so well beyond adolescence, and may persist throughout life or subside over time.”

What are the symptoms of paroxysmal supraventricular tachycardia?

We are not normally aware of our heartbeat unless an event increases its volume or speed. In the case of paroxysmal supraventricular tachycardia, palpitations (average 160 beats per minute) are clearly felt for about 10-30 minutes and often goes along with it the blurring of visioni.e. blurred vision and a general feeling of malaise which in the most severe cases can lead to fainting.

“Sometimes, the episode has a trigger, such as an intestinal flu where the diarrhea causes a loss of electrolytes, such as magnesium and potassium, which are necessary for the muscles, including the heart, to contract properly, which causes this latent arrhythmia to occur.”

also alcohol abuse, drug use, unbalanced diet or obesity they can act as triggers, while other times the onset is unexplained. “Usually the patient fears a heart attack, while Tpsv is generally a benign pathology that is not life-threatening,” reassures Dr. Ugo. “Fortunately, in fact, the heart is equipped with a structure, the atrioventricular node, which “filters” the transmission of electrical impulses from the atria to the ventricles: since it is the latter, i.e. the lower chambers of the heart, that dictate the rhythm, the block imposed by the AV node prevents the heart rate from reaching excessive levels. In other words, it reaches high, but not so high as to cause cardiac arrest.”

How is paroxysmal supraventricular tachycardia diagnosed?

To make a diagnosis of paroxysmal supraventricular tachycardia, a objective examination of the patient and a careful history, which highlights the various aspects of the problem (when it occurs, how often, what are the associated symptoms, how long it lasts, and so on).

“At that point, based on the frequency of episodes, treatment can be prescribed 24-hour dynamic Holter ECG, which records the heart rate over a 24-hour period, but which can also be used for 48 hours or more, up to 5-7 days,” explains Dr. Ugo. “Unlike an electrocardiogram, which takes a few seconds, this test allows you to monitor the heart’s electrical activity over an extended period of time in order to increase the chances of detecting a possible episode of paroxysmal supraventricular tachycardia and understanding when it occurs. ».

However, if Tpsv occurs very sporadically, you can resort recording loop, a small device implanted under the skin to continuously record the heart rate for 2-3 years, reporting any arrhythmias directly to the hospital where it was placed. “Alternatively, today’s technology can help with modern humans smart watches with an electrocardiogram function, which should be started when you feel the heart speeding up abnormally.”

How to deal with it paroxysmal supraventricular tachycardia

To permanently solve the problem, you can usetranscatheter ablation: once the heart is reached with specific catheters running through the veins or femoral arteries, the areas in the atrial tissue that may be the point of origin of the arrhythmia are electrically isolated, creating a “block” of the electrical signal and avoiding the wrong circulation.

“However, there are no drugs able to cure the problem: some active ingredients could limit the episodes, but not avoid them completely,” says Dr. Ugo. “Although it is a routine intervention in cardiology, ablation scares patients. With the referring specialist, it is a good idea to find the most suitable solution for your needs: if the episodes are sporadic and you learn to manage them, surgery can be avoided. If, however, TPSV occurs frequently or if a possible fainting could jeopardize the safety of the individual or others for professional reasons, it is a good idea to consider ablation, which is well tolerated, effective, practically without complications and fast, because only 20-30 minutes».

How to manage it paroxysmal supraventricular tachycardia

For now, how can you manage its episodes paroxysmal supraventricular tachycardia? “The attack can be blocked by simultaneous compression of the bulbs, to be exercised with the thumbs: to be effective, the pressure must be of such an extent as to cause slight pain, so it should be learned from a specialist doctor to avoid damage to the eyes,” concludes Dr. Ugo. “Alternatively, you can do it crouch on the ground, with your knees close to your chest, or you can squeeze your stomach, as in an attempt to have a bowel movement. These simple maneuvers are able to calm the heart and return it to a normal rhythm.”

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