The Enid News and Eagle, Enid, OK

November 7, 2012

Ectopic heartbeats: How serious?

By Judy Rupp, columnist
Enid News and Eagle

— Elaine’s heart just wouldn’t let her rest. Driving the car, working in the garden, talking on the phone or lying in bed, she was acutely aware of the thumping, flopping feeling inside her chest.

After performing necessary tests, Elaine’s doctor assured her that her heart was sound and that the irregular heartbeats she was experiencing posed no threat to her health. But there was still the matter of rest; the thumping and pounding were keeping her awake at night and making it hard for her to concentrate on anything.     

Ectopic or abnormal heartbeats are common, occurring in nearly every adult from time to time. An occasional irregular beat may go unnoticed or be felt as a brief fluttering or odd feeling in the chest. Often referred to as “skipped beats,” they actually represent extra contractions that occur just before the natural beat.    

Many persons, like Elaine, have hundreds of these contractions every day, sometimes accompanied by chest pain, dizziness or other symptoms that may send them rushing to the emergency room, fearing a heart attack.    

Most ectopic beats are either PVCs (premature ventricular contractions) or PACs (premature atrial contractions) depending on where they originate. The heart is made up of four chambers — two upper chambers or atria. and two lower chambers known as ventricles. Premature ventricular contractions occur in the lower chambers and PACs in the upper.    

In most cases, PVCs and PACs are entirely normal, but persons feeling symptoms such as Elaine’s should see a doctor, if for no other reason than to ease their minds.      

Abnormal contractions can be caused by a heart attack, an inflamed heart or a problem with heart valves such mitral valve prolapse.

To rule out these causes, a doctor is likely to perform a physical examination and order tests such as an EKG (electrocardiogram), echocardiogram and/or an exercise stress test. One way of detecting the irregular beats and distinguishing them from more serious heart rhythm problems is through having the patient wear a Holter monitor or event recorder to track the heart’s rhythm while the person is involved in everyday activities.    

A blood test can detect abnormalities in cardiac enzymes that might signal heart muscle damage or electrolyte imbalances that might be contributing to the problem. It can also rule out causes such as a hyperactive thyroid, drug toxicity or abuse of cocaine or amphetamines.    

Many of the possible causes of PVCs and PACs are serious medical conditions that require prompt treatment. And it’s important to distinguish irregular beats from a more serious irregular rhythm such as atrial fibrillation. Atrial fibrillation causes pooling of blood in the upper chambers of the heart, creating the risk of blood clots and a stroke. Premature contractions, on the other hand, do not interfere with the heart’s normal rhythm in this way.    

Reasons for the ectopic beats are not always easy to find. They could result from age-related diseases or changes in the heart or other organs of the body. More likely, they are related to anxiety, stress or lifestyle issues such as smoking, diet, caffeine or alcohol use.

In an otherwise healthy person, even very frequent ectopic beats are no reason for concern, although the patient may want treatment to relieve the symptoms.

Triggers vary from person to person, but patients are usually advised to quit smoking and to cut back on or eliminate caffeine and alcohol use. In many individuals, regular exercise can help regulate heart beats, reduce stress and contribute to better overall health.  For most individuals, the most important treatment is stress reduction through controlled breathing, yoga, meditation or biofeedback. Simply knowing the ectopic beats are normal and no cause for alarm goes a long way toward relieving anxiety.

Serious palpitations usually require some medical treatment, often with a beta blocker or a calcium channel blocker.    

What patients experiencing vigorous thumping in the chest tend to fear most is that their hearts will go out of control? An arrhythmia in the lower chambers of the heart, known as ventricular fibrillation, is a life-threatening condition. PVCs can occur in persons with severe heart problems that create a risk of ventricular fibrillation. But if you have a healthy heart with abnormal beats, you should rest assured that your heart is not going out of control.

Rupp is a certified information and referral specialist on aging for NODA Area Agency on Aging. Contact her at 237-2236.