Distinguishing Between Premature Beats and Atrial Fibrillation Symptoms

The difference between premature beats and atrial fibrillation?

Hello Dr.
He,
Today (October 5th) in the morning, I felt a "thud" sensation in my chest again, which I believe is a "premature beat." After that, I did not experience any discomfort.
I followed your advice this time to relax and not to be too anxious after the premature beat occurs, to avoid triggering it again.
Additionally, I found information stating that symptoms of atrial fibrillation include: "Some patients with atrial fibrillation may experience palpitations (a sudden pounding or fluttering sensation in the chest), fatigue, dizziness, chest discomfort, and shortness of breath." The description of a sudden pounding or fluttering sensation in the chest seems quite similar to my "thud" feeling.
However, you previously mentioned that my situation is more akin to "premature beats."
I would like to ask you the following questions:
1.
Do both premature beats and atrial fibrillation present with a "thud" sensation in the chest?
2.
Following up on that, how can premature beats and atrial fibrillation be distinguished based on their symptoms?
Thank you, Dr.
He.

Axiang, 30~39 year old female. Ask Date: 2021/10/05

Dr. He Dongjin reply Cardiology

Hello, everyone experiences sensations differently.
The feeling of a thump in the chest is referred to as palpitations.
It doesn't necessarily indicate a problem, and it's difficult to diagnose conditions like premature beats or atrial fibrillation based solely on symptoms.
At your age, the likelihood of developing atrial fibrillation is not high.
If previous examinations have not shown any significant abnormalities, it is advisable to observe the situation without overthinking it and scaring yourself.
Changhua Hospital cares about your well-being.

Reply Date: 2021/10/05

More Info

Distinguishing between premature beats (premature atrial contractions or PACs and premature ventricular contractions or PVCs) and atrial fibrillation (AF) can be challenging, especially when symptoms overlap. Here’s a detailed explanation to help clarify the differences between these two conditions, particularly focusing on the symptoms you mentioned, such as the "thump" sensation in your chest.

1. Symptoms of Premature Beats vs. Atrial Fibrillation
Premature Beats:
- Thump or "Skipped Beat" Sensation: Many individuals describe the feeling of a premature beat as a "thump" or "skipped beat." This sensation occurs when the heart's normal rhythm is interrupted by an early contraction. After the premature beat, there is often a compensatory pause, which can lead to a feeling of a stronger heartbeat afterward.

- Frequency and Duration: Premature beats can occur sporadically and may be felt occasionally throughout the day. They are often benign and may not be associated with any significant symptoms.

- Associated Symptoms: While some people may experience mild palpitations or a fluttering sensation, most do not experience severe symptoms. Anxiety or stress can exacerbate the perception of these beats.

Atrial Fibrillation:
- Irregular Heartbeat: AF is characterized by an irregular and often rapid heart rate. Patients may feel their heart racing or fluttering, and the rhythm can be erratic.

- Associated Symptoms: In addition to palpitations, individuals with AF may experience fatigue, dizziness, shortness of breath, chest discomfort, or even fainting. These symptoms can be more pronounced than those associated with premature beats.

- Duration: AF can be paroxysmal (intermittent), persistent, or permanent. Episodes may last from a few minutes to hours or longer, and they may require medical intervention to restore normal rhythm.

2. Distinguishing Between the Two
Key Differences:
- Rhythm Regularity: The most significant difference is the regularity of the heartbeat. In premature beats, the heart rhythm is generally regular, with occasional interruptions. In contrast, AF presents with an irregularly irregular rhythm.

- Heart Rate: AF often results in a higher heart rate, which can be rapid and variable, while premature beats typically do not significantly alter the overall heart rate.

- Symptoms Severity: Symptoms associated with AF tend to be more severe and can lead to significant discomfort or distress, while premature beats are often benign and may not cause any significant symptoms.

Conclusion
Given your description of feeling a "thump" in your chest, it is likely that you are experiencing premature beats, especially since you mentioned that there were no other accompanying symptoms. However, if you ever experience more pronounced symptoms such as persistent palpitations, dizziness, or shortness of breath, it is crucial to seek medical attention.
It's also important to remember that anxiety can amplify the perception of heartbeats, leading to increased awareness of both premature beats and AF. If you find that anxiety is a significant factor in your experience, discussing this with a healthcare provider may provide additional strategies for management.

In summary, while both premature beats and atrial fibrillation can present with similar sensations, they differ significantly in rhythm regularity, heart rate, and associated symptoms. If you have ongoing concerns or if your symptoms change, it would be advisable to consult with your healthcare provider for further evaluation and management.

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