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Have premature atrial contractions. When should I be worried?

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Practicing since : 1966
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At what point, if at all, do I need to worry about Premature Atrial Contractions or SVE's? I believe I have them occasionally and they make me anxious when they occur and I feel them but I don't feel them most of the time when I'm busy. Are there signs to watch out for while having them? I wore a halter for 24 hours last month and it only picked up 4 singles and 4 pairs, but I now feel like I'm having them a little more often.
Posted Sat, 2 Mar 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 4 hours later
Hi friend,
Welcome to Health Care Magic

     These ectopic beats are not always symptomatic. The feeling depends on individual sensitivity – some do not feel them at all / some may feel every beat.
     Premature Atrial Contractions or SVE / APCs are generally harmless. Even VPCs are often harmless – ‘benign’.
If they are frequent - more than 5 per hour, 2 or more beats coming consecutively – they are investigated further.
     ECHOcardiogram is done to see the heart valves (Mitral Valve Prolapse) / heart muscle (Cardiomyopathy) and heart function (Ejection fraction, wall motion abnormality).
      TMT (Treadmill exercise ECG) is done to exclude Ischemia (reduced blood flow).
     LABORATORY work-up is routine - like blood counts, sugar, urea, electrolytes (potassium in particular), thyroid (over-active) and so on.

     If the change is 20 or more beats in a minute / if the heart rate is more than 100 / if you have chest pain / if you are breathless – you need to see your doctor soon. Even here, generally it may lead to Supra ventricular tachycardia or Atrial fibrillation – which are generally well tolerated for some time and not usually a dire emergency

     If the problem is still bothering to the extent of interfering with life style, there are advanced techniques of investigations of increasing complexity – Electro Physiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out / suitable medicine tested and so on. Though the test is the gold standard, it is INVASIVE and has a risk (though minimal) and is not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. The treating doctor may suggest them depending on need, based on his assessment of the situation.

     As it is, you don’t have to worry about it now / just ignore them / repeat the Holter after one year / earlier, if you are symptomatic.

Take care
Wishing speedy recovery
God bless
Good luck
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