Supraventricular Tachycardia (heart Arrhythmia)

[12R3G]

I originally posted this in the C&P forum; for some reason, as soon as I logged in this entire category (General VA Claims...) disappeared. Anyway, I think this is the most appropriate venue, so I have reposted it here.

90% SC overall (94% to be precise).

The good news: heart arrhythmia is SC. SMR state symptoms "consistent with SVT". Two C&P exams verify heart arrhythmia as does SMR documenting several episodes that I acutually went to the doctor for over a 3+ year period, as well as statements to docs at time describing the ones I didn't go to the doctor for. Generally, 6 or more episodes per year of heart arryhthmia.

Bad news: never captured on ECG (typical for SVT), holter monitor or event monitor. the events were too sporadic for a 24 hour monitor and I was never offered a long term (30+) event monitor. I've had all the stress tests (stress, thallium stress, stress echocardiagram) which were negative which only proves that my SVT is not triggered by exercise/exertion (again, not unusual). Instead, I was diagnosed--by AF doctors--with SVT and placed on beta blocker which is one of the standard treatment options.

CFR 38 rating schedule: 7010 Supraventricular arrhythmias: Paroxysmal [just means episodic vs continuous] atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor: 30%

According to the Mayo Clinic, SVT is a broad term that includes many forms of arrhythmia originating above the ventricles (supraventricular). SVTs usually cause a burst of rapid heartbeats (160 - 200 bpm) that begin and end suddenly and can last from seconds to hours.

The VA, while granting SC, claims that I have some non-rateable heart arrythmia that isn't SVT--despite the classic symptoms leading to the clinical diagnosis and treatment. I sumitted a reconsideration and was denied, still at 0%. With 6-8 episodes per year prior to going on the beta blocker (and almost none since) I should be at 30%.

So now what? IME from my primary physician (internal medicine)? Visit to a cardiologist for an IME? Obviously the VA is hanging its decision on the fact that this isn't "documented by ECG or Holter monitor" but I'm not taking a beta blocker cause I like pills--I have enough to take already! The Catch 22 is that beta blocker is doing its job by preventing the SVT.

Any suggestions? Thanks...

12R3G

[purple]

Hi-

I have (had) SVT as well. I've had 2 cardiac ablation procedures to correct this condition and been on numerous meds. I was recently dx with "sick sinus syndrome" and now have a pacemaker. I only tell you this, so you know that I'm very familiar with EKGs, Holter Monitors and the King-of-Heart Monitor (30-day) tests, Stress Tests....all of that stuff.

I'm really wondering how the AF docs dx your SVT without a positive EKG or Holter Test? You said that your SMRs and C&P exam document the SVT, is this based on symptoms or is there an EKG? Just curious.

[12R3G]

Symptoms...in addition to SVT, I have DMII, HBP, Sleep Apnea, and assorted other stuff. So, after several visits to the doc after the episodes that didn't last long enough to get to a hospital even if I tried (coulda called an ambulance, but that seemed like overkill at the time) with the same set of symptoms (palpiations, rapid heartbeat/pulserate [~190], elevated bp during episode, faint/light headedness, sweat/cold-clammy, etc., etc.) he said that my symptoms equated to SVT and put me on metoprolol 25mg (since upped to 50 mg by my civilian doc). the mil doc discussed the holter monitor, but since it wasn't an everyday occurance he didn't think it was worth the effort. He mentioned the 30-day monitor, but then decided to go straight to treatment.

No one disputes the arrhythmia, just that it is a SVT. Which makes no sense the more I look into this, as everything I've read indicates that SVT is almost a catchall that can describe a host of atrial (i.e., non-ventricular) arrhythmias.

The VA put me on a holter monitor the 2nd C&P I went on for this, but nothing (did I mention the metoprolol?). I even had my primary doc put me on a 30-day, but again the metoprolol is doing its job too well.

I know the VA is blocking this because of the ECG/holter monitor requirement...but the anti-arrhythmial is stopping the arrhythmia, which is what it is supposed to do.

[purple]

Sounds like you're between the proverbial rock & hard place here. From all the cardiologists I've been too in the civilian world (and it's been quite a few) they've told me they would never dx my SVT w/o seeing it on an EKG..more than once...a Holter; or the 30-day monitor.

I'm not doubting that you have some sort of issue going on, as obviously the betablocker has taken your symptoms away. I'm just shocked that it was prescribed based on symptoms alone.

In the beginning, they thought my SVT was "panic attacks" as the symptoms are the same (palpatations, rapid heartbeat, sweating, dizziness, elevated BP)...so it wasn't until they actually saw the irregular hearbeat on the monitor on several occasions that they realized it was SVT.

I'm just going by my experience here....I guess all cardiologists are different.

Hopefully, the fact that the dx is in your SMRs will be enough.

Be sure you have copies of everything.

[deltaj]

I originally posted this in the C&P forum; for some reason, as soon as I logged in this entire category (General VA Claims...) disappeared. Anyway, I think this is the most appropriate venue, so I have reposted it here.

90% SC overall (94% to be precise).

The good news: heart arrhythmia is SC. SMR state symptoms "consistent with SVT". Two C&P exams verify heart arrhythmia as does SMR documenting several episodes that I acutually went to the doctor for over a 3+ year period, as well as statements to docs at time describing the ones I didn't go to the doctor for. Generally, 6 or more episodes per year of heart arryhthmia.

Bad news: never captured on ECG (typical for SVT), holter monitor or event monitor. the events were too sporadic for a 24 hour monitor and I was never offered a long term (30+) event monitor. I've had all the stress tests (stress, thallium stress, stress echocardiagram) which were negative which only proves that my SVT is not triggered by exercise/exertion (again, not unusual). Instead, I was diagnosed--by AF doctors--with SVT and placed on beta blocker which is one of the standard treatment options.

CFR 38 rating schedule: 7010 Supraventricular arrhythmias: Paroxysmal [just means episodic vs continuous] atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor: 30%

According to the Mayo Clinic, SVT is a broad term that includes many forms of arrhythmia originating above the ventricles (supraventricular). SVTs usually cause a burst of rapid heartbeats (160 - 200 bpm) that begin and end suddenly and can last from seconds to hours.

The VA, while granting SC, claims that I have some non-rateable heart arrythmia that isn't SVT--despite the classic symptoms leading to the clinical diagnosis and treatment. I sumitted a reconsideration and was denied, still at 0%. With 6-8 episodes per year prior to going on the beta blocker (and almost none since) I should be at 30%.

So now what? IME from my primary physician (internal medicine)? Visit to a cardiologist for an IME? Obviously the VA is hanging its decision on the fact that this isn't "documented by ECG or Holter monitor" but I'm not taking a beta blocker cause I like pills--I have enough to take already! The Catch 22 is that beta blocker is doing its job by preventing the SVT.

Any suggestions? Thanks...

12R3G

I suggest you have a really knowlegable service officer from a service organization review your Service Medical Records to determine whether a CUE claim should be filed on whether V.A. made an error in initially rating your condition as 0%.

[sharon]

The VA has acknowledged that you have the condition, however it is not compensable. Should it increase in severity you will receive monetary compensation.

[Hoppy]

12R3G

Have you ever been screened or otherwise discussed the possibility that you are having what is called hyperventilation episodes or panic attacks. There was a veteran who was on hadit about a year ago who was diagnosed with a heart condition and discharged in the early 70’s, After service he went through many tests and post service doctors would not confirm any heart condition. Instead they diagnosed him with panic attacks. Panic attacks have the same symptoms you discussed. I have had panic attacks where my pulse rate gets over 150 for several minutes. I have also called 911 and had the symptoms resolve before the ambulance got to me.

While trying to help this veteran I remember reading some medical articles that stated that the heart condition he was diagnosed with in the military could not be diagnosed in the manner in which the military doctors made the diagnosis. Sorry I cannot remember details.

I suggested to the veteran that he file a claim for service connection of panic attacks and get a statement from a doctor that his diagnosis in the military was not sufficiently verified to eliminate panic attacks and that the fact that the heart condition cannot currently be verified makes it more likely than not that he ever had a heart condition. As such the condition in the military was consistent with panic attacks which have continued to be sufficiently chronic to indicate that it is more likely than not that the current condition of panic attacks is related to the symptoms diagnosed in the military. This would be a medical determination. I did not hear back from the veteran to see if the doctor would agree.

Get your SMR’s and re-read them there could be things in there that you forgot about. There might be something in there about hyperventilation episodes. I am service connected for a condition I forgot about and many years later I read my SMR and filed a claim that I won.

I do not trust anything the VA does. I am helping a veteran who has been granted a non service connected pension for PTSD due to events that occurred in the military. They non service connected him for PTSD with MDD. He has never been diagnosed with PTSD with MDD. He was diagnosed with Panic Disorder with MDD. His SMR’s support a diagnoses of panic disorder. I am of the opinion the reason they non service connected him for PTSD is because they want him to waste his time trying to get PTSD service connected. What I am saying is that just because a rater says you have a heart condition I would verify it with a doctor. Raters have ulterior motives. I had raters make up all kinds of lies when denying my claim. I won my claim on appeal with no new evidence. The DRO was amazed at the way my claim was denied.

Edited September 10, 2009 by Hoppy