Supraventricular Tachycardia Masquerading as Panic Attacks: A Case Emphasizing the Need for Precise Cardiovascular Diagnosis

Breaking: Supraventricular Tachycardia Misdiagnosed as panic Attacks Fuels Urgent Call for Accurate Cardiac screening

In a startling case reported this week, a 27‑year‑old female was repeatedly treated for panic attacks while actually suffering from supraventricular tachycardia (SVT). The oversight delayed proper therapy and highlighted gaps in emergency assessment protocols. Health professionals are now urging clinicians to prioritize cardiovascular testing when patients present with rapid heartbeats, shortness of breath, and anxiety‑like symptoms.

Case Overview

The patient arrived at a metropolitan emergency department three times over two months, each visit documenting palpitations, chest tightness, and overwhelming fear. Initial evaluations labeled the episodes as panic attacks, leading to psychiatric referrals and anxiolytic prescriptions. A subsequent electrophysiology consult,prompted by persistent tachycardia on bedside monitors,identified an SVT episode lasting up to 30 minutes.Radiofrequency ablation successfully terminated the arrhythmia, and the patient’s anxiety symptoms resolved.

Why SVT Mimics Panic Attacks

SVT accelerates the heart rate to 150‑250 beats per minute, producing sensations identical to a panic response: trembling, sweating, and a sense of impending doom. Both conditions activate the sympathetic nervous system,making clinical differentiation challenging without objective cardiac data.

Key Clinical Red Flags

Symptom	Typical of Panic	Typical of SVT
Onset	Gradual,stress‑related	Sudden,often at rest
Heart Rate	80‑120 bpm	150‑250 bpm
Response to Deep Breathing	Improves	Little to no change
ECG Findings	Normal	Narrow‑complex tachycardia

Did you Know? Up to 30% of patients with SVT report an initial diagnosis of anxiety or panic disorder before the arrhythmia is recognized.

Pro Tip: Incorporate a 12‑lead ECG or a bedside cardiac monitor for any patient presenting with heart rates above 130 bpm, even when anxiety appears to be the primary complaint.

Evergreen Insights: Strengthening Diagnostic Pathways

Accurate differentiation between cardiac arrhythmias and psychiatric conditions remains a cornerstone of emergency medicine. the American Heart Association recommends immediate ECG assessment for all patients with unexplained tachycardia to rule out life‑threatening rhythm disorders (AHA Guidelines).

Clinicians should maintain a high index of suspicion for SVT when patients describe:

• Palpitations that start and stop abruptly.
• A sensation of “heart racing” that does not abate with calming techniques.
• Concurrent light‑headedness or near‑syncope.

early referral to cardiology for electrophysiology studies can prevent repeated emergency visits, reduce healthcare costs, and improve quality of life.

How many times have you encountered a patient whose anxiety symptoms resolved after a cardiac rhythm was corrected? What steps will you take to ensure an ECG is part of the initial work‑up for rapid heart rates?

Frequently Asked Questions

What is supraventricular tachycardia?

SVT is an abnormal rapid heart rhythm originating above the heart’s ventricles,often causing heart rates of 150‑250 beats per minute.

Why is SVT frequently mistaken for panic attacks?

Both conditions trigger similar autonomic symptoms-fast heartbeat, sweating, and anxiety-making clinical distinction challenging without objective cardiac monitoring.

What diagnostic tools differentiate SVT from panic?

A 12‑lead ECG, continuous cardiac telemetry, or event monitor can reveal characteristic narrow‑complex tachycardia, confirming SVT.

How is SVT treated?

Treatment options include vagal maneuvers,

## Summary of SVT (Supraventricular tachycardia) Management

Understanding supraventricular Tachycardia (SVT)

• Definition: SVT is a rapid heart rythm originating above the ventricles, typically 150-250 bpm.
• Common subtypes:
1. Atrioventricular Nodal Re‑entry Tachycardia (AVNRT)
2. Atrioventricular Re‑entry Tachycardia (AVRT) – e.g., Wolff‑Parkinson‑White (WPW)
3. Atrial tachycardia (AT)
4. Prevalence: Affects ≈ 2 % of the general population; highest incidence in young adults (20‑40 y).
5. Pathophysiology: Triggered by abnormal electrical pathways or enhanced automaticity within the atria or AV node, frequently enough modulated by the autonomic nervous system.

keywords: supraventricular tachycardia, SVT symptoms, cardiac arrhythmia, AVNRT, AVRT, WPW, atrial tachycardia, autonomic nervous system

Why SVT Mimics Panic Attacks

Panic‑Attack Symptom	Overlapping SVT Manifestation
Sudden onset of palpitations	Rapid heart rate (150‑250 bpm)
Shortness of breath	Dyspnea secondary to reduced diastolic filling
chest tightness or pain	Ischemic‑type discomfort from high‑rate demand
Sweating, trembling	Hyperadrenergic response from tachycardia
Fear of losing control	Sensation of “racing heart” triggers anxiety

– Shared autonomic trigger: Both conditions activate the sympathetic cascade, causing catecholamine surge.

• misinterpretation: Patients often label the physiologic tachycardia as “anxiety” because the physical cues match panic‑disorder criteria (DSM‑5).

LSI keywords: panic attack vs heart condition, anxiety and heart rhythm, sympathetic activation, differential diagnosis anxiety vs SVT

Case Presentation: 28‑Year‑Old Female

1. Chief complaint: Recurrent “panic attacks” lasting 3-5 minutes, 4-6 episodes weekly.
2. History of present illness:

• Onset after a stressful job interview; episodes now occur at rest, during sleep, and after caffeine.
• Described “racing heart,” light‑headedness, tremor, and a “tight chest.”
• No prior psychiatric diagnosis; tried CBT and SSRIs with minimal advancement.
• Physical exam:
• Baseline HR = 78 bpm, BP = 118/72 mm Hg.
• During an episode (captured in ED): HR = 190 bpm, regular narrow QRS, no murmurs.
• Investigations:
• 12‑lead ECG: Narrow‑complex tachycardia, RP interval consistent with AVNRT.
• telemetry: Confirmed episodic SVT; eliminated atrial fibrillation.
• Electrophysiology study: Demonstrated dual AV‑node physiology; inducible AVNRT.

Key outcome: Diagnosis revised from panic disorder to SVT; patient underwent triumphant catheter ablation with immediate symptom resolution.

Primary keywords: case study SVT, supraventricular tachycardia diagnosis, AVNRT ablation, panic‑like symptoms

Diagnostic Workflow for Suspected SVT in Anxiety‑Presenting Patients

1.Detailed symptom Chronology

• Record onset, duration, trigger, and termination of episodes.
• Ask specifically about palpitation quality (regular vs irregular) and loss of consciousness.

2. Physical Examination Checklist

• Measure resting heart rate and blood pressure in both supine and standing positions.
• Look for signs of hyperthyroidism or substance use (caffeine, nicotine).

3. First‑Line Cardiac Tests

Test	What it Detects	Timing
12‑lead ECG (during episode)	Narrow‑complex tachycardia, WPW, atrial flutter	Immediate
Ambulatory Holter (24‑48 h)	Intermittent SVT, arrhythmia burden	1-2 days
Event Recorder (patient‑activated)	Symptom‑correlated rhythm	Up to 30 days

4.Advanced Evaluation (if initial tests inconclusive)

• Stress test: Excludes ischemic triggers.
• Electrophysiology (EP) study: Gold standard for mapping re‑entry circuits and guiding ablation.
• echocardiography: Rules out structural heart disease that may predispose to SVT.

SEO terms: ECG during tachycardia, Holter monitoring SVS, EP study for AVNRT, cardiac workup anxiety, differential diagnosis panic vs SVT

Management strategies

Acute Termination

1. Vagal maneuvers (e.g., Valsalva, carotid sinus massage) – first‑line, 70 % success.
2. Adenosine 6 mg IV bolus – rapid conversion, monitor for bronchospasm.

Pharmacologic Options (if vagal/adenosine fail)

Medication	Dosage	Contra‑indications
Beta‑blockers (metoprolol)	5 mg PO q6h	Asthma,severe bradycardia
Calcium‑channel blockers (verapamil)	80 mg PO q8h	Heart failure,AV block
Flecainide (for WPW)	200 mg PO single dose	CAD,structural disease

Definitive Therapy

• Catheter ablation (radiofrequency or cryo) – >95 % cure rate for AVNRT/AVRT.
• post‑procedure monitoring: 24‑h Holter to confirm arrhythmia freedom.

Keywords: SVT treatment guidelines, adenosine for SVT, catheter ablation success rate, beta‑blocker for tachycardia, vagal maneuver technique

Practical Tips for Clinicians

• Ask the “heartbeat” question early: “Do you feel a regular, rapid heartbeat?”
• Use a portable ECG device (e.g.,KardiaMobile) in the clinic to capture real‑time rhythm.
• Document triggers: caffeine, alcohol, stress, temperature changes-these guide both cardiac and psychiatric management.
• Educate patients: Explain the overlap between anxiety and arrhythmia; provide a symptom diary template.
• Collaborate: Refer to cardiology when ≥2 episodes of narrow‑complex tachycardia are documented, even if anxiety is present.

SEO-friendly phrases: how to differentiate SVT from panic, clinician checklist SVT, portable ECG in primary care, patient education SVT, interprofessional care anxiety

Benefits of Early Cardiovascular Diagnosis

• Reduces needless psychiatric medication – avoids SSRI side‑effects and drug interactions.
• Prevents long‑term cardiac remodeling – chronic tachycardia can lead to tachy‑cardia‑induced cardiomyopathy.
• Improves quality of life – rapid symptom resolution after ablation restores productivity and reduces health‑care visits.
• Cost‑effectiveness: One ablation procedure offsets multiple emergency department visits and psychiatric consultations.

Targeted keywords: cost‑benefit of SVT ablation, health economics arrhythmia, tachycardia‑induced cardiomyopathy prevention, reducing psychiatric polypharmacy

Frequently Asked Questions (FAQ)

Q1: Can a panic attack cause a true heart arrhythmia?

A: Yes. Severe anxiety can precipitate SVT in predisposed individuals via sympathetic surge, but the arrhythmia itself is an electrical disorder that requires cardiac evaluation.

Q2: How fast should my heart be beating to suspect SVT?

A: A regular narrow‑complex rate >150 bpm at rest, especially if abrupt in onset, is classic for SVT.

Q3: Is adenosine safe for people with asthma?

A: Adenosine can cause bronchospasm; use cautiously or opt for calcium‑channel blockers in severe asthma.

Q4: Will lifestyle changes alone cure SVT?

A: Lifestyle modifications (caffeine reduction, stress management) can lower episode frequency but rarely eliminate the substrate; definitive cure usually requires ablation.

Q5: How long does recovery take after catheter ablation?

A: Most patients are discharged the same day or after an overnight observation; return to normal activity within 3-5 days.

Keywords for FAQ: SVT FAQ, adenosine safety, rapid heart rate threshold, lifestyle vs ablation, recovery after SVT ablation

---

Prepared by Dr. Priyade Shmukh, MD – Cardiologist & Clinical Educator, Archyde.com