For medical students and others who want to see some nice animations of various forms of supraventricular tachycardias (SVT) in living color, be sure to checkout the free SVT animations at Blaufuss.org (requires Adobe Shockwave player available from the site).
-Wes
h/t Vijay Sadasivam, MD via Facebook and Ves Dimov, MD via Twitter
Showing posts with label SVT. Show all posts
Showing posts with label SVT. Show all posts
Wednesday, June 23, 2010
Tuesday, February 26, 2008
Cubs' DeRosa and the Management of SVT
Mark DeRosa, the Cub's second baseman, was reported today to have flown back to Chicago from spring training in Mesa Arizona to be "examined by a cardiologist at Northwestern Meemorial Hospital, but only expects to miss one week of camp."
That should be about right. After all, he has a very curable condition called "SVT" - short for supraventricular tachycardia.
My bet: he'll be "cured" before the close of business today and use the rest of the week to convalesce.
On second thought - he'll probably be playing again Monday.
Most likely, he has garden-variety AV nodal reentrant tachycardia, a loop-the-loop heart rhythm caused when two halves of the normal AV node (which connects the top and bottom chambers of the heart electrically) create a circular path around which the electricity can travel quickly - to the tune of about 150-200 beats per minute typically. One pathway usually conducts quickly, and the other, more slowly. The fact that he can do "manuvers" to stop the rhythm (usually a "Valsalva maneuver" - forced expiration against a closed mouth) - is very suggestive that this is this cause for his racing heart beats. The straining maneuver causes slowed conduction through the pathways, but the slower-conducting pathway occassionally stops its conduction briefly, allowing the regular rhythm to resume.
Catheter ablation, or cauterizing (burning) the slower-conducting pathway in the AV node, when performed correctly, has a very high cure rate and relatively low complication rate, but involves about a two- to three-hour procedure where wires are passed throught the veins in the legs to the heart, and the location of the slow pathway cauterized to destroy the extra-conducting pathway. No long-term medications are required. Certainly, for the person unwilling to risk the procedure, medications (like beta blockers or calcium channel blockers) can be used to help control the arrhythmia by blunting heart rate response - not a likely scenario for a pro-baseball player to accept.
I wish Mr. DeRosa the best of luck, and look forward to seeing him back on the field soon.
-Wes
UPDATE: 27 Feb 2008 17:00 - It's sometimes nice to say I told you so. (Heh, this wasn't a tough call - but I think DeRosa's making the right choice here...)
ADDENDUM: 1 Mar 2008: All's well that ends well.
That should be about right. After all, he has a very curable condition called "SVT" - short for supraventricular tachycardia.
My bet: he'll be "cured" before the close of business today and use the rest of the week to convalesce.
On second thought - he'll probably be playing again Monday.
Most likely, he has garden-variety AV nodal reentrant tachycardia, a loop-the-loop heart rhythm caused when two halves of the normal AV node (which connects the top and bottom chambers of the heart electrically) create a circular path around which the electricity can travel quickly - to the tune of about 150-200 beats per minute typically. One pathway usually conducts quickly, and the other, more slowly. The fact that he can do "manuvers" to stop the rhythm (usually a "Valsalva maneuver" - forced expiration against a closed mouth) - is very suggestive that this is this cause for his racing heart beats. The straining maneuver causes slowed conduction through the pathways, but the slower-conducting pathway occassionally stops its conduction briefly, allowing the regular rhythm to resume.
Catheter ablation, or cauterizing (burning) the slower-conducting pathway in the AV node, when performed correctly, has a very high cure rate and relatively low complication rate, but involves about a two- to three-hour procedure where wires are passed throught the veins in the legs to the heart, and the location of the slow pathway cauterized to destroy the extra-conducting pathway. No long-term medications are required. Certainly, for the person unwilling to risk the procedure, medications (like beta blockers or calcium channel blockers) can be used to help control the arrhythmia by blunting heart rate response - not a likely scenario for a pro-baseball player to accept.
I wish Mr. DeRosa the best of luck, and look forward to seeing him back on the field soon.
-Wes
UPDATE: 27 Feb 2008 17:00 - It's sometimes nice to say I told you so. (Heh, this wasn't a tough call - but I think DeRosa's making the right choice here...)
ADDENDUM: 1 Mar 2008: All's well that ends well.
Wednesday, December 05, 2007
Adrenalin Rush
What happens to your heart rate when you skydive? It's pretty impressive:I purchased a heart rate monitor and tested it out on a very intense skydive. a RAFT DIVE. You can see my heart rate skyrocket during freefall.Yep.
Now you can see what my heart rate did when during the ~24 minute ride in the plane up. It was pretty consistent at about 130 bmp which is still pretty freakin high. Look at it shoot waaaay up during our 1 minute freefall. 240 bpm???
But then again, I wonder if he has SVT?
-Wes
Monday, February 19, 2007
The Denial-of-Payment Game
“Hello, Ms. Nicestpersonintheentireworld.”
“Hi.”
“How are you feeling after your ablation?”
“Tired. You know I was in the hospital for pneumonia?"
“No, I’m sorry, I wasn’t aware that you were admitted.”
“Yeah, they thought my CT looked bad, so they put me on antibiotics for a while, so I’m recovering from that. And you know what else?”
Gulping and concerned what would come next, “No, what?”
“The insurer won’t pay for my ablation.”
“What??? You mean they won’t pay for a person with documented supraventricular tachycardia (SVT) at 180 b/min that occurred in the hospital while you were receiving treatment for your breast cancer that was very symptomatic? The same SVT that was refractory to medical therapy and required several doses of adenosine to correct?”
“That’s right. They’re denying payment saying I didn’t need the ablation – they said you should have called the insurer first and that I should have been treated with drugs first.”
“But you were in the hospital... So even though you’ve got lung disease and use inhalers, they want me to use drugs first and even though this flies in the face of established guidelines?.”
“I guess so.”
It’s all a big game, this denial of payment thing. Here’s the score as I see it:
* * * S C O R E B O A R D * * *
ROUND 1:
Patient: 0, Insurance Company: 1
Now we have 14 more rounds to go to get this settled, if we're lucky. And meanwhile, Ms. Nicestpersonintheentireworld not only gets to deal with all the aspects of her cancer care, she gets to worry about whether she gets to pay for the ablation, too.
-Wes
“Hi.”
“How are you feeling after your ablation?”
“Tired. You know I was in the hospital for pneumonia?"
“No, I’m sorry, I wasn’t aware that you were admitted.”
“Yeah, they thought my CT looked bad, so they put me on antibiotics for a while, so I’m recovering from that. And you know what else?”
Gulping and concerned what would come next, “No, what?”
“The insurer won’t pay for my ablation.”
“What??? You mean they won’t pay for a person with documented supraventricular tachycardia (SVT) at 180 b/min that occurred in the hospital while you were receiving treatment for your breast cancer that was very symptomatic? The same SVT that was refractory to medical therapy and required several doses of adenosine to correct?”
“That’s right. They’re denying payment saying I didn’t need the ablation – they said you should have called the insurer first and that I should have been treated with drugs first.”
“But you were in the hospital... So even though you’ve got lung disease and use inhalers, they want me to use drugs first and even though this flies in the face of established guidelines?.”
“I guess so.”
It’s all a big game, this denial of payment thing. Here’s the score as I see it:
* * * S C O R E B O A R D * * *
ROUND 1:
Patient: 0, Insurance Company: 1
Now we have 14 more rounds to go to get this settled, if we're lucky. And meanwhile, Ms. Nicestpersonintheentireworld not only gets to deal with all the aspects of her cancer care, she gets to worry about whether she gets to pay for the ablation, too.
-Wes
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