R on T phenomenon

jnette, ASN, EMT-I · Mar 10, 2005

Would love to hear more on this...

have been throwing a LOT of PVC's here myself lately... couplets, tripletts, even quads.

One morning I woke up to a run of EIGHT in a row ! :uhoh21:

No consistent pattern, but these will continue for days at a time. :stone

Cardiologist feels it's related to my occasional SVT's.. but in what way, she never did say. :confused:

Why would I have them so consistently even when not having an SVT episode?

Last night before I drifted off to sleep I had about 30 seconds worth... I'm assuming it was a short run of VT.. very scary ! :eek: NOT SVT's, either.. I can tell/feel the difference.. but also VERY rapid.. too fast to count. Heavy and pounding. Had I not already been lying down, I think I would have passed out, because nausea and diaphoresis overtook me at the same time.

Any explanations?

RE Agent · Mar 10, 2005

Would love to hear more on this...
have been throwing a LOT of PVC's here myself lately... couplets, tripletts, even quads.
One morning I woke up to a run of EIGHT in a row ! :uhoh21:
No consistent pattern, but these will continue for days at a time. :stone
Cardiologist feels it's related to my occasional SVT's.. but in what way, she never did say.
Why would I have them so consistently even when not having an SVT episode?
Last night before I drifted off to sleep I had about 30 seconds worth... I'm assuming it was a short run of VT.. very scary ! NOT SVT's, either.. I can tell/feel the difference.. but also VERY rapid.. too fast to count. Heavy and pounding. Had I not already been lying down, I think I would have passed out, because nausea and diaphoresis overtook me at the same time.
Any explanations?

Does it show up on the monitor/EKG?

I had PSVT once, because I drank some tea in Japan. My heart was beating so fast, and I was sweaty, never felt like passing out. Converted with vagel stim.

Could you be going thru the change? That will make your heart do funny things.

jnette, ASN, EMT-I · Mar 10, 2005

Does it show up on the monitor/EKG?
I had PSVT once, because I drank some tea in Japan. My heart was beating so fast, and I was sweaty, never felt like passing out. Converted with vagel stim.
Could you be going thru the change? That will make your heart do funny things.

No... sis has SVT's too... runs in the family I guess. Has been going on for many years for her.. only the past three for me. Often will convert on my own just like that.. sometimes not. All the vagaling in the world doesn't work for me. Has nothing to do with coffee, tea, etc... tried it all. Calcium Channel Blockers taken at onset of episode work for sis within ten minutes.. not for me. Ten years post menopause, so no, not that.

The svt's aren't the big issue.. I know a lot of ppl have this. But the nealrly daily and all day long PVCs since the LAST svt episode almost two mos. ago is what's bothering me. Never had pvc's before... and especailly not of this magnitude.. IF I might have had one now and then... never was aware of them before. Now I am VERY aware of them. They're constant.

Just like the short v tach runs... NOT PACs, NOT SVTs... I can feel the difference. The overwhelming and SUDDEN sweaty, nausea, passing out feeling came with the 30 seconds or more tach last night... never does that with svt's.. just get a little tingly, lightheaded and SOB with those if I don't convert in a half hour or around that. Last svt episode had to be converted with adenosine. But this last night was WAY different.

Just wondered if the svt's can precipitate PVCs... this is what my cardiologist implied.. but I'm not so convinced.

Having ablation done in the next few weeks.. from what I hear, this will knock out the svt's AND the PVC's. Hope so !

URO-RN · Mar 11, 2005

Ask for a holter monitor to see if you can capture the events.

This R on T phenomenon is quite dangerous. F/U with doc ASAP if found to have this rhythm.

http://www.heartcenteronline.com

this and many other sites on the net have good info. on this and other dysrythmias.

I, too suffer from SVT and I do throw PVC's.... I had a EP study w/ablation with no success. I opted for meds. I take lopressor and this tends to work for me.

athomas91 · Mar 11, 2005

jnette

have they tested you or your sister for WPW??

gwenith, BSN, RN · Mar 11, 2005

Jnette - if you haven't already get your magnesium level checked OK??

Tenesma · Mar 11, 2005

for the OP

1) r on t is often misread - and actually isn't really r on t.

2) your MD was mistaken: all symptoms of arrhythmia should be evaluated (Chest pain, syncope/pre-syncope, headache, nausea, etc...)

3) pairs of PVC are no big deal

4) if she had a history of syncopal events, etc... then getting a referral to EP lab to see if she is fib. inducible, may be warranted (and then implant an ICD)

5) If she is asympt. and has no hx, then have her follow up w/ cards for a holter...

hollyster · Mar 11, 2005

My patient in the GI lab came out to recovery with way to many PVC's, > 6/min. Some the PVC R waves fell right in the middle of the T wave. She did not have any cheat pain, and her b/p was fine. The MD said this was o.k. as long as she did not have chest pain. What do you all think? I've always thought R on T was dangerous with or without chest pain. She was also having pairs (couplets) of PVC's.

Did the pt have a procedure that required contrast? I see this happen quite often with heart cath pts. Has nothing to do with the cath itself but is induced by contrast. Some people are very sensitive to it, I recently had to defib a pt in a cath who went into R on T as soon as the test injection of dye was injected. In the CCU I have seen it happen with pts who have gone for GI studies.

Pete495 · Mar 11, 2005

Even if you've been evaluated on a holter monitor, I would have it done again. In fact, I would have it done annually or, just so you know what is going on. How can you know what rhythm you are if you don't hook yourself up to a monitor every now and then. Also, make sure you are getting normal amounts of calcium, potassium, and magnesium in your diet. Have these checked every now and then too. These are very important for your heart conduction. An ICD might not be a bad idea either, but as Tenesma said, you should be put in an EP lab too.

jnette, ASN, EMT-I · Mar 11, 2005

Jnette - if you haven't already get your magnesium level checked OK??

Gwenith.. I had labs drawn at the cardiologist's office last week...potassium, calcium all within normal limits... I am surprised, however, that my magnesium was not checked in these labs??? I would have THOUGHT they should be, and never asked specifically, as I just assumed it would have been included.

Choesterol was high, however, but not OVERLY high... 255. But my LDL was 166 and they were not happy about that. And I am NOT a "grease eater", either ! Very careful with my fats and oils and what KINDS of fats, oils I use, etc. Triglycerides were great.. rather low, actually.

JoAnne... I have no B/P. 90/60 or lower is baseline. Can't go with these pressors or beta blockers/calcium channel blockers or most of the antiarrythmics.. and I really don't wan't to take meds for the rest of my life, either. Thought the ablation would be the best shot.. have heard they have a great success rate, but I guess not ALWAYS, eh? Bummers. Guess I should try, anyway.. maybe I'll be one of the lucky ones.

Did the lopressor knock out your pvc's, too?

Yes, I've been to heart ctr. online and several other informative sites as well.

No, sis has never been tested for WPW.. but hers stop in ten minutes after taking a calc. chnl. blkr.

I can't afford to have to run up to the ER on the hill to be converted all the time when this happens at work... :rolleyes:

Afterall, I have PATIENTS to take care of !!! :rotfl:

lifeLONGstudent · Mar 15, 2005

JoAnne... I have no B/P. 90/60 or lower is baseline. Can't go with these pressors or beta blockers/calcium channel blockers or most of the antiarrythmics.. and I really don't wan't to take meds for the rest of my life, either. Thought the ablation would be the best shot.. have heard they have a great success rate, but I guess not ALWAYS, eh? Bummers. Guess I should try, anyway.. maybe I'll be one of the lucky ones.

My mom was in a similar situation as you. She suffered from PSVT (AVnode re-entry PSVT). Most of the time, she could 'control' it with valsalva maneuver, but over the years she also had a few (5) trips to the ER. She is a stubborn woman and naturally her SVT was stubborn too. Each time, she converted with Adenosine, but usually took 2 or 3 doses... and that is a little scary to see your mom flatline momentarily after they push the Adenocard (although I knew it was coming, it still scared the 'excrement' out of me). Anyway, her rates were in the 240s while in SVT (SCARY TOO!!!). Her normal resting HR was about 50. (BP is about 95/60). She was put on 12.5mg of Topril... well, that made her brady down into the 30's and that is just not adequate cardiac output (duh!!!)...so the blockers were not an option for her either. We did ablation. It worked and has been such a blessing! I say go get an EP study done and try it. Her Cardio-EP doc warned that if the abn. conduction pathway was too close to the AV node, then they would not attempt to ablate.... even if you were not a candidate for ablation, maybe they could insert an ICD during the EP study (?? so it could pace you before you get to the point where you need to be cardioverted???). I feel for you. Good luck with whatever treatment options you go with.