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Have had a aortic heart valve replacement. Why am I experiencing extra heartbeat?

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Practicing since : 1966
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Hello Doctor,

I generally have a regular heartbeat. Lately, I experience an extra heartbeat, especially in the evening. I had a aortic heart valve replacement over a year ago. This recent extra heartbeat has been going on for several hours this evening. I'm having no pain or other symptoms. I don't notice the symptoms during the day, if they happen then. I notice my heartbeat in my ears at night when I lying down.

Posted Mon, 26 Nov 2012 in Heart Rate and Rhythm Disorders
Answered by Dr. Anantharamakrishnan 35 minutes later
Hi friend
Welcome to Health Care Magic

You need further assessment and assistance.
You should see your cardiologist, as soon as possible.

Irregular heart beats need to be documented by ElectroCardioGram (EKG).
Ectopic beats can be from ventricle (lower chamber - Ventricular Ectopic; VPC) or Atrium (upper chamber - Atrial Ectopic; APC). If they are frequent (More than 5 per hour, 2 or more coming in succession –they need investigations further.

In your context – valve replacement and bypass - heart is the prime suspect.
[Anxiety / Alcohol / Tobacco / Caffeine (too much coffee, cola) are common causes. Medicines may be responsible – like phenlephrine, pseudoephedrine used for ‘cold’ / salbutamol, salmeterol used for asthma]

it is advisable to investigate, as soon as possible.
     A thorough history and physical examination is the first step -
     Routine 12-lead Electrocardiogram (ECG) is part of clinical examination.
     If a routine ECG does not show, 24 to 48 hour ambulatory monitoring (Holter) is done to analyse and plan for further management
     ECHOcardiogram is necessary to see the valves / muscle / and function (Ejection fraction, wall motion abnormality).
     Treadmill exercise ECG (TMT) may be in need to exclude recurrent ischemia.
     Laboratory work-up is routine - like blood counts, sugar, urea, electrolytes (potassium in particular), thyroid (over-active) and so on. The treating doctor will suggest based on the situation.

     If there are no clues and they are troublesome, there are more tests - like Electro Physiological Studies (EPS) – the test is invasive, has a risk (though small) and is not generally done unless there are compelling indications. The treating doctor may suggest them based on the situation.
     The first line medicine is generally beta blockers – probably you are already receiving. The dose may need to be upped.
If they are not effective and if the problem is severe, several other classes of drugs are available – - acting by different mechanisms - the specialist will decide tailored to the individual / they may have side effects and need frequent follow up.
There are other advanced treatment modalities - like RF ablation.

You need further assessment and assistance.
You should see your cardiologist, as soon as possible.

Take care
Wishing speedy recovery
God bless
Good luck
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