Can SVT Episodes Cause Chest Pain?
Yes, chest pain is a well-recognized symptom of supraventricular tachycardia episodes and occurs in approximately 5% of documented SVT presentations, though chest discomfort is reported even more frequently during acute episodes. 1
Clinical Evidence for Chest Pain During SVT
The ACC/AHA/HRS guidelines explicitly document chest pain as a presenting symptom in SVT patients:
In a retrospective study of patients with Wolff-Parkinson-White syndrome, chest pain was documented as the presenting mode in 5% of cases, alongside other presentations including documented SVT (38%), palpitations (22%), and syncope (4%). 1
Chest discomfort is listed among the core arrhythmia-related symptoms that patients with paroxysmal arrhythmias experience, along with palpitations, fatigue, lightheadedness, dyspnea, and presyncope. 1
Recent clinical studies confirm that chest pain, chest discomfort, and throat/neck/jaw discomfort are among the most common adverse reactions during SVT episodes, with incidence rates exceeding 10% in some populations. 2, 3, 4
Mechanisms Underlying Chest Pain in SVT
The chest pain associated with SVT episodes occurs through several physiological mechanisms:
Myocardial ischemia can develop because prolonged tachycardia increases myocardial oxygen demand while simultaneously decreasing coronary perfusion time due to shortened diastole. 5
Increased atrial pressures from atrial contraction against a closed AV valve (particularly in AVNRT) can cause chest discomfort, similar to the mechanism that produces the characteristic "neck pounding" sensation. 1
Hemodynamic compromise during SVT episodes decreases arterial pressure and increases left atrial pressure, which can manifest as chest discomfort. 1
Important Clinical Distinctions
When evaluating chest pain in SVT patients, consider these critical points:
Differentiate SVT-related chest pain from acute coronary syndrome. Patients presenting with symptoms or signs of acute myocardial ischemia require immediate evaluation, as fatal cardiac events including myocardial infarction have occurred during SVT episodes. 2
Chest pain severity varies with ventricular rate, underlying heart disease, SVT duration, and individual patient perceptions. 1
Persistent SVT with fast ventricular response lasting weeks to months can lead to tachycardia-mediated cardiomyopathy, which itself can cause chest pain and heart failure symptoms. 6, 5
Clinical Pitfalls to Avoid
Do not dismiss chest pain in SVT patients as purely anxiety-related, as 54% of SVT patients have had their symptoms incorrectly attributed to panic, anxiety, or stress, with women more likely to be mislabeled than men. 1
Never overlook the possibility of underlying structural heart disease (valvular disease, hypertrophic cardiomyopathy) that could make chest pain during SVT more concerning. 1
In patients with pre-excitation syndromes (Wolff-Parkinson-White), chest pain during rapid SVT warrants urgent evaluation due to the risk of extremely rapid ventricular rates that can degenerate into ventricular fibrillation. 5