..ad nauseum

Yesterday's episode began as I was finishing a snack of hummus and a cracker before dinner. I felt the now familiar adrenalin surge followed by my heart beginning to palpitate. I walked quickly to the bedroom where my  oximeter/pulse meter was and read a 174 bpm. I tried several val salva maneuvers including the imitation of a person blowing up a balloon. No clear result. We got in the car and headed for the ER--again. They reacted quickly. This time, alarmingly, they strapped on shock electrodes for possible use. EKG showed the high rate with lots of PVCs, but they said the rhythm looked stable, though fast. The ER doc had me lie flat, take a breath and hold while exerting the downward abdominal pressure of the val salva maneuver. At the same time, he lifted both my legs straight up as though he was stretching my hamstrings (which he did a little). Down came the HR! Everyone was happy. An X-ray to see whether there was anything about lung condition contributing to this was negative. Blood lab was normal. 90 min after arrival, I was on the way home, with the admonition not to exert myself. Didn't seem as though I was before the onset of the PSVT. I did have a stimulating lunch with friends and this seems to correlate with an attack later on only because I am always lunching with friends. Yesterday I had a good morning at the piano and did no lifting, so exertion seemed minimal.

I did find out that on the prior ER visit I was given adenosine. It is quick acting and stops the heart for a second or two. They also administered a rate stabilizer (diltiazem) and as I mentioned in a prior post, some Xanax (alprazolam)

Cardiology Consult

I wanted to establish a relationship with a local cardiologist in the same clinic in which my primary care occurs. A new doc replaced the cardiologist I started seeing the prior year just before he retired. We had a good discussion. His analysis: I am headed for another ablation. He will watch from the sidelines. As it happens, I am scheduled next week for a session with the doc who did the prior ablations. He moved very quickly with those when my heart was cleared by the heart failure team last year and I expect he will move quickly again. That appointment is 4 days hence. The day  before that I meet with the heart failure clinic. 

There are risks with an ablation for recurrent PSVT. Apparently there are two pathways close together that communicate from ventricles to atria. One needs to go. But sometimes both are inadvertently ablated because they are so close. At this point ventricles and atria cannot communicate leading to a pacemaker implant. The new doc was surprised that they didn't do a PSVT ablation at the same time they did the atrial flutter and atrial fibrilation ablations last year. He said that while atrial ablations are about 70% effective, about 90% of PSVT ablations are usually effective. We'll see about all of this on Tuesday in consultation with the experts.