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Feeling of ‘dropping / skipping / missed’ beat points ECTOPIC beats.
Ectopic beats can arise from ventricle (lower chamber of the heart - Ventricular Ectopic; VPC) or Atrium (upper chamber - Atrial Ectopic; APC).
APCs are generally harmless. Even VPCs are often harmless – ‘benign’.
Irregular heart beats need to be DOCUMENTED by ElectroCardioGram (ECG / EKG).
THE FIRST STEP IS TO SEE A CARDIOLOGIST
Anxiety / Alcohol / Tobacco (smoking) / Caffeine (too much coffee, cola) are common causes.
Medicines may be responsible – like Phenylephrine
used for ‘cold’
Illicit ‘drugs’ like Amphetamine
are notorious to cause abnormal beats
At times, abnormal nerve paths in the heart (bypass tracts) are responsible!
It is advisable to have it investigated.
A thorough history and physical examination is the first step -
ECG (Electrocardiogram / EKG) – Routine 12-lead – is part of clinical examination.
HOLTER is done to analyse and plan for further management, if a routine ECG does not show, 24 to 48 hour ambulatory monitoring
is necessary 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. Your Internist shall suggest based on the situation.
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 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.
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. Your doctor will give proper prescription and follow up
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 your needs / they may have side effects and need follow up.
There are other advanced treatment modalities - like RF ablation, which could be done during EPS.
Relax. Be positive – why fear the heart beats faster? The problem is only if it could not beat!
You are tolerating the rate well - means that you may not have any basic disease of the valve, muscle and so on.
Be in touch with your doctor - it is a question of time and you will be well.
Medicine is well advanced nowadays – management is possible for almost all situations...
Wishing speedy recovery