Af

[Deb]

Dr. Fett,
Will you try to clear something up for me? I've been having a fluttering type feeling in my chest, in the upper part of my heart. It comes and goes. The past couple of days it's been fairly regular.

I was just sleeping and woke up with chest pain and very distinct fluttering in my heart. I checked my HR and it was 88 - not bad. I looked up atrial fibrillation and saw a video of what it looks like and it looks just like how my heart feels.

Is it possible to have AF and a normal HR? Or is it possible my heart monitor isn't picking up all the beats if it's too fast or weak? I've been to the ER twice recently for high HRs 150 - 170 and really don't want to go again if this is just something benign and I'm way off base with I think it is.

Thank you for your help.

[JAMESFETT]

If you did have atrial fibrillation, your monitor may not accurately record your heart rate. Of course a "fluttering" sensation is somewhat concerning about heart rhythms, so the only way to be sure is to monitor and if you have an "event" to then record it and see if there is any association with heart rhythm. Hope it checks out fine.

JD

[reezlemom]

Just want to say - I don't have AF, but I do have SVT (also a rapid atrial arrythmia). My experience is that when I have that arrythmia, or even a couple of ectopic beats, the machine reads "ERROR".

[Deb]

I ended up at the ER last night due to the fluttering problem. After sitting on the monitor in the ER for several hours, the only thing we noticed was that I would be in sinus rhythm and when I would feel the fluttering, the monitor would change and say SV rhythm.

The PA wasn't concerned about it and said "You're okay, you're not having a heart attack. Besides, you've got an ICD so you've got more insurance than I've got."

I came home.

What does SV rhythm mean?

[Erin]

Scary, Deb! I hope everything stays benign. Wishing you peace of mind and good health!

[JAMESFETT]

SV = supraventricular; at least that is the common abbreviation. In the electrical system of the heart there is the "sinus node" (where normal rhythms start) followed by the "A-V junction" followed by the " Common Bundle of Purkinje" followed by the left and right bundles.

Any rhythm originating above the A-V junction is a "supraventricular" rhythm, such as "normal sinus," "paroxysmal atrial tachycardia," "supra-ventricular tachycardia," "atrial flutter," "atrial fibrillation" or "atrial flutter-fibrillation."

So, it seems to me, your "SV rhythm" needs more defining. Do you need to see an electrophysiologist cardiologist? Your cardiologist will tell you.

JD

[Deb]

I will be following up with my EP Wednesday. I called the NP in Boston that I generally deal with and she's out until then, actually both of the ones I know are.

My EP is aware that I've been having issues with SVT for the past few months, thus the increase to 150 toprol XL. I guess it's not working.

Thanks for the input.

Oh, my potassium was 3.0, so they did put me on potassium. Does that change anything?

[JAMESFETT]

On any rhythm issues, it is very important to have normal serum potassium levels. Going along with potassium is serum magnesium, often not measured, but probably just as important as potassium. Is your serum magnesium normal? Do you take diuretics? Is that why your serum potassium is low?

JD

[Deb]

I only take diuretics as needed. I took one on Christmas Eve, but not since. My labs show my calcium is low, potassium is low, but glucose is high. Nothing about magnesium.

[JAMESFETT]

Low serum potassium can also be caused by increased kidney losses of potassium and from an excess of the hormone, aldosterone, from the adrenal gland. That is also associated with hypertension. If your low potassium is not from taking diuretics it may be advisable to do other-cause checks.

JD

[reezlemom]

I ended up at the ER last night due to the fluttering problem. After sitting on the monitor in the ER for several hours, the only thing we noticed was that I would be in sinus rhythm and when I would feel the fluttering, the monitor would change and say SV rhythm.

The PA wasn't concerned about it and said "You're okay, you're not having a heart attack. Besides, you've got an ICD so you've got more insurance than I've got."

I came home.

Sorry about your icky night, though I'm glad they caught it. Try not to get discouraged about the meds not taking care of this; SVT can sometimes be a bugger when it comes to good control. Hope you're feeling a little relieved at least knowing that that feeling is.