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Have occasional ectopic beats or missed beat. Possibility of heart failure?

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sir i have occasional ectopic beats or missed beat after meal and in the early the morning.During halter test ectopic beats may be in the range of 0000 for 24 hours something. Doctor say no need to worry few people have this type of heart functioning. But i have a habit to watch and notice this pulse rate.Some times i feel very up set due to this. My question is is there any possibility of heart attack or heart failure.My TMT test is negative and halter also negative and lipid profile rating HDL -35, LDL 130 , total 191, trigliceride 130.
Posted Wed, 14 Nov 2012 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 1 hour later
Hi friend
Welcome to Health Care Magic

In the beginning, you said the ‘Holter’ is abnormal (By the end, you say ‘halter’ is negative!?) – I feel it is typing error?!). Ectopic beats can be from ventricle (lower chamber - Ventricular Ectopic; VPC) or Atrium (upper chamber - Atrial Ectopic; APC). APCs are generally harmless. Even VPCs are often harmless – ‘benign’. If they are frequent (More than 5 per hour, 2 or more coming in succession –they need investigations further.

We do TESTS –
     ECHOcardiogram is necessary to see the heart valves (Mitral Valve Prolapse) / heart muscle (Cardiomyopathy) and heart function (Ejection fraction, wall motion abnormality) – Have you done it?
     Treadmill exercise ECG (TMT) is done to exclude Ischemia (reduced blood flow) – OK in your case
     Laboratory work-up is routine - like blood counts, sugar, urea, electrolytes (potassium in particular), thyroid (over-active) etc. The treating doctor will suggest based on the situation.
There are advanced techniques of investigations of increasing complexity more (some of them invasive), depending on need

There are many CAUSES –
     Anxiety / Alcohol / Tobacco (smoking, chewing) / Caffeine (too much coffee, cola) are common causes.
     Medicines may be responsible – like phenylephrine, pseudoephedrine used for ‘cold’ / Salbutamol, Salmeterol used for asthma / Illicit ‘drugs’ like amphetamine are notorious to cause abnormal beats
     Rarely, there are abnormal nerve paths (bypass tracts) in the heart.

     Do NOT worry about ’Heart attack’. The chances are remote.
     Do NOT worry about ‘Heart Failure’ – You don’t have now. The chances of getting it also are remote.

     In your case it is possibly from tension? (Anxiety)

     Your LDL cholesterol is high. LDL (& non-HDL) is ‘bad’ cholesterol – lower, the better. HDL is OK – higher, the better. Regular exercise and healthy eating (low cholesterol diet) are necessary - a good dietician will help. Repeat after 6 weeks. If it is high – despite diet and exercise – you need drugs; statin is the first choice.
     Beta blockers are generally started. Metoprolol – slow release and small dose – will benefit both anxiety and missed beats. Your doctor will give proper prescription and follow up

Please scan and send us the summary of the report of Holter (generally it is the last page).
Please scan and send us the summary of the report of ECHO cardiogram (generally it is the last page).

See you again
Take care
Wishing you speedy recovery
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Have occasional ectopic beats or missed beat. Possibility of heart failure? 50 minutes later
sorry for missing information. kind attention is invited on the following.

TMT test negtive.
Echo test negative.
Halter test- negative with pre mature super ventracular ectopic seen. 0000 in 24 hour.
Blood sugar - fasting 98, PP -110,
lipid profile - HDL -35
LDL -130
total -191

my question is why i feel this ectopic beats and what is the treatment for that.Despite regular consult in several renowned hospital i am getting these frequent ectopic .
Answered by Dr. Anantharamakrishnan 4 hours later

     These ectopic beats could be normal in some persons. The feeling depends on individual sensitivity. Some do not feel them at all / some may feel every beat. There are several investigations, already suggested. If there are no clues and if you are still bothered by it to the extent of interfering with life style - there are more tests - like 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. The test is invasive, has a risk (though small) and is not generally done unless there are compelling indications. You don’t need it. Have a trail of drugs.
     The first line medicine is generally beta blockers. If they are not effective and if the problem is severe, several other classes of drugs are available – they may have lot of side effects and need frequent follow up.
     The best solution is to stick to ONE CARDIOLOGIST – preferably ELECTROPHYSIOLOGIST.

Regarding, cholesterol, I have already written last time

Take care / Wishing you speedy recovery
God bless you / Good luck
Above answer was peer-reviewed by
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