Paroxysmal supraventricular tachycardia (PSVT) is episodes of rapid heart rate that start in a part of the heart above the ventricles. "Paroxysmal" means from time to time.

PSVT; Supraventricular tachycardia

Symptoms usually start and stop suddenly, and can last for a few minutes or several hours. They can include:

• Anxiety
• Chest tightness
• Palpitations (a sensation of feeling the heart beat), often with an irregular or fast rate (racing)
• Rapid pulse
• Shortness of breath

Other symptoms that can occur with this condition:

• Dizziness
• Fainting

If you do not have symptoms or any other heart condition, PSVT may not need treatment.

If you have an episode of PSVT, there are techniques you can try on your own to interrupt the fast heartbeat.

• One is called the Valsalva maneuver. To do this, you hold your breath and strain, as if you were trying to have a bowel movement.
• Another technique you can try is to cough while sitting with your upper body bent forward.
• Some people find that splashing ice water on the face is helpful.

You should avoid smoking, caffeine, alcohol, and illicit drugs.

Emergency treatment to slow the heartbeat back to normal may include:

• Electrical cardioversion, the use of electric shock
• Medicines through a vein

Long-term treatment for people who have repeat episodes of PSVT, or who also have heart disease, may include:

• Cardiac ablation -- a procedure used to destroy small areas in your heart that may be causing the rapid heartbeat (currently the treatment of choice for most PSVTs)
• Daily medications to prevent repeat episodes
• Pacemakers to override the fast heartbeat (on occasion may be used in children with PSVT who have not responded to any other treatment)
• Surgery to change the pathways in the heart that send electrical signals (this may be recommended in some cases for people who need other heart surgery)

PSVT is generally not life threatening. If other heart disorders are present, it can lead to congestive heart failure or angina.

Call your health care provider if:

• You often have a sensation of feeling the heart beat quickly and symptoms do not end on their own in a few minutes
• You have a history of PSVT and an episode does not go away with the Valsalva maneuver or by coughing, or other symptoms occur with the rapid heart rate
• Symptoms return often
• New symptoms develop

Olgin JE, Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. St. Louis, Mo: WB Saunders; 2011:chap 39.

Zimetbaum P. Cardiac arrhythmia with supraventricular origin. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 64.