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Irregular heart beat. Normal pulse and BP. What should be wrong?

Hi, Im 52 years old, when I had 4 beers and dinner I came home and fell asleep about 2 hrs. later on the sofa, my heart was beating very irregular and lasted 4 hrs. this has happened twice in the last month, I dont drink much at all.I have had irregular beating the last 6 months,I did go see my md.and the did a24 hr monitor and he said I have early heart beat not to worry, but this is different, my blood pressure is perfect 117 over 75 and my resting pulse is 68. I feel the problem more so when at rest, I go on my exersize bike 3 to 4 times a week, get my pulse up to 120 and I feel fine. any thoughts
Asked On : Sat, 26 Jan 2013
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Cardiologist 's  Response
Hi friend,
Welcome to Health Care Magic

You have ectopic (missed) beats.
From your description, atrial fibrillation is a possibility.
They should be investigated further.

Alcohol is most likely to cause.
Anxiety / Tobacco (smoking) / Caffeine (too much coffee, cola) are also common causes.      
At times, abnormal nerve paths in the heart (bypass tracts) are responsible!

It is wiser to repeat the HOLTER (24-hour monitor).
ECHOcardiogram 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.

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 depends on the diagnosis / may not always be necessary.
Cutting down the alcohol will help.
The first line medicine is generally beta blockers, like Metoprolol. If 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.

Take care
Wishing speedy recovery
God bless
Good luck
Answered: Sat, 26 Jan 2013
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