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Suffering from extra heart beats. Done with EKG, nuclear stress test, and an ECG. On beta blockers. Suggestions?

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I have been suffering from extra heart beats. My doctor has doen an EKG, a nuclear stress test, and an echo cardiogram. I had suffered from this for a while and then went a year with no symptoms. Two weeks ago, I had an episode where I had an extra beat many times per minute for 6 hours and then one for 4 hours and then one for three hours. I went to emergency room and they told me I was fine, even though they were seeing the extra beat on the monitor at a frequent basis. I took the ekg into my cardiologist who saw the extra beat and he said there was nothing to worry about but he would put me on beta blockers 50 mg per day to see if that helped .. are the doctors right that I am fine. The anxiety is getting to me.
Posted Wed, 21 Aug 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 29 minutes later
Hi friend,
Welcome to Health Care Magic

Normal ECHO practically excludes major structural anomalies...
Nuclear stress test has excluded Coronary Artery Disease as the cause...

Anaemia / Anxiety / Alcohol / Tobacco (smoking) / Caffeine (too much tea, coffee, cola) / Fever / Infection / Pain / Stress / Thyroid / Vitamin D, calcium, magnesium / Medicines like Phenylephrine used for ‘cold’; Salbutamol used for asthma and so on - may be responsible.... / Illicit ‘drugs’ like Amphetamine are notorious to cause abnormal beats / At times, abnormal nerve paths in the heart (bypass tracts) or disease of the conduction system may be responsible!

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. Many cases of palpitation are benign , especially when associated with normal ECHO and may not require treatment, If you also have symptoms like blurred vision, dizziness, loss of consciousness, shortness of breath, chest pain along with this, you need further and urgent work up

Specific treatment may not always be necessary. The first line medicine is generally beta blockers, like Metoprolol – slow release and small dose. It will benefit both anxiety and missed beats. You are in good hands... everything is proper...

If there are no clues and if the problem is still bothering to the extent of interfering with life style, there are advanced techniques of investigation – Electro Physiological Studies (EPS). Though the test is the gold standard, it is INVASIVE 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. There are other advanced treatment modalities - like ablation (thermal or radio-frequency), which could be done during EPS.

You are well / you just need follow up...that is all.

Take care     
Wishing speedy recovery
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Suffering from extra heart beats. Done with EKG, nuclear stress test, and an ECG. On beta blockers. Suggestions? 5 hours later
Thank you for your response. The internet makes you crazy with the sudden death talks, etc. My cardiologist seems confident that there is nothing wrong, but when it happens it is scary. I just want to make sure that everything is fine to put my mind at ease. I sent the EKG along with my previous question. I just wanted to ask as a follow up, is there a certain number of skip beats that should cause me to be concerned. Like I said, the past few incidents seemed to last for hours and seemed to be coming at every third beat or so. Also, are the beta blockers safe to be on? I have noticed that my heart rate is down to about 52 beats per minute?
Answered by Dr. Anantharamakrishnan 5 hours later

The internet is an ocean of information – uncensored!
It can often confuse individuals, not related to the speciality...

I have already seen the EKG / it is basically NORMAL except for the 3 ‘skipped beats’...

Beta blockers are quite safe / they have been in use for several decades...
Which of them are you using? I presume either metoprolol or atenolol?
Rate of 52 is on the lower side, but still no cause for concern. If you are stable for some time, the dose of the drug can be reduced...

Generally, if they are frequent - more than 5 per hour, 2 or more beats coming consecutively – they should be investigated further. It is not simply the number - there are several other features, your doctor will look for. Leave it to him and relax!

You had been tolerating the rate well, for several hours - means that you are unlikely to have any basic disease of the valve, muscle and so on.
You are alright / you will be alright...

Above answer was peer-reviewed by
Follow-up: Suffering from extra heart beats. Done with EKG, nuclear stress test, and an ECG. On beta blockers. Suggestions? 2 days later
Thank you doctor. Yes, I am on Atenolol. 25 mg every 12 hours. It was knocking me out so now I am just taking it once a day in the late afternoon because it seems like I am more prone to having skipped beats later on in the day. ... Doctor, one last question, as I stated, I went a year with no symptoms at all. What would all of a sudden cause these skipped/extra beats to come on now? It just seems weird that I would have no symptoms and then one day have an episode with multiple skipped beats every minute for an entire 6 hour period and then it stops and then 12 hours later another similar episode for hours and then it stops and then two days later another episode for hours, then I go without a week of anything and then have another 3 hour episode. .. I am just trying to figure out why this is doing this and will it get worse as I get older. Last year I had skipped beats, as I told you, but never had continuous episodes of consistent skipped beats for hours .. So is there a reason for this and should I expect this to continually get worse as I get older?
Answered by Dr. Anantharamakrishnan 5 hours later

     The underlying cause is there since long / may be inherited and from birth! The manifestation depends on other factors influencing it, both XXXXXXX and external – Anxiety, alcohol, caffeine and tobacco are some common ones...
     Age has no direct influence / Degeneration, Coronary Artery Disease and so on can have a role
     There are several classes of drugs and several drugs in each class / Your cardiologist can choose / supplement and supplant the present drug...

Good luck
Above answer was peer-reviewed by
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