Atrial Premature Contractions: Causes, Symptoms, and Management

Atrial premature contraction (APC)

Hello, Director.
I would like to ask about my condition.
In September, I was diagnosed with atrial premature contractions (APCs), and a 24-hour Holter monitor showed five APCs in one day.
An echocardiogram revealed mitral valve prolapse and some degree of valve regurgitation.
Initially, I was taking CARTIL TABLETS 30MG twice a day, but during my follow-up appointment on November 19, the doctor said I could reduce the dosage since I hadn't experienced many APCs in the past three months—only about once every few weeks.
However, on November 26, I suddenly began experiencing frequent APCs, each lasting about 15-30 minutes, with more than 20 occurrences each time.
Deep breathing also triggered APCs, and I experienced them at various times throughout the morning, noon, and evening.
This has left me feeling shocked and disappointed; I had finally managed to reduce my medication, but now I am experiencing frequent APCs again.
I would like to ask if this indicates a worsening of my condition or if it has become more serious.
Previously, I did not experience APCs during exercise, but now they occur with minimal activity.
Am I in danger? I rushed back for a follow-up on November 27, and the doctor switched my medication to Kankun 1.25mg once daily and instructed me to wear a Holter monitor for seven days.
What should I do? I have been feeling very depressed and anxious over the past two days.
How can I get through these seven days without experiencing frequent APCs again? Will I be in danger? I have a few questions for you: 1.
Has my condition worsened? 2.
Do I need to undergo any additional tests? 3.
What should I do about the sudden increase in APCs? Should I stop exercising immediately if I experience APCs during physical activity? 4.
Why has there been a sudden increase in APCs? Is it life-threatening? I also had a coronary CT scan, and all three coronary arteries were clear with no stenosis.
Despite taking my medication regularly and exercising, I suddenly find myself in this situation, which makes me feel hopeless.
Please help me! Why has there been a sudden increase in APCs? Each time I experience an episode, I feel like rushing to the emergency room, but by the time I get there, the APCs have subsided.
I am attaching my echocardiogram report for your reference.
Echocardiogram Report Date: 2021/09/10
Conclusion:
• Left ventricular enlargement
• Preserved global contractility of the left ventricle
• Left ventricular ejection fraction (LVEF) by M-mode is 60.4%
• Regional wall motion abnormality, cause to be determined
• Grade I diastolic dysfunction (impaired relaxation)
• Mitral valve prolapse (borderline)
• Mild mitral regurgitation
• Mild pulmonary regurgitation
• Mild tricuspid regurgitation
• Estimated systolic pulmonary artery pressure is 21.3 mmHg
M-mode/2D Measurements & Calculations:
RWT: 0.34
Time Measurements:
R-R interval: 0.82 sec
M-mode/2D Value References:
Aortic root diameter: 3.1 cm [2.0-3.8 cm]
Left ventricular internal diameter in diastole (LVIDd): 5.8 cm [3.7-5.3 cm]
Aortic cusp separation (ACS): 1.9 cm [1.6-2.6 cm]
Left ventricular internal diameter in systole (LVIDs): 3.9 cm [2.4-3.6 cm]
Left atrial dimension: 3.5 cm [1.9-4.0 cm]
End-diastolic volume (EDV, Teich): 166.6 ml [80-180 ml]
End-systolic volume (ESV, Teich): 65.9 ml [16-83 ml]
Mitral valve E-F slope: 17.3 cm/sec [8.0-15.0 cm/sec]
Ejection fraction (EF, Teich): 60.4% [50-70%]
Interventricular septal thickness in diastole (IVSd): 1.0 cm [0.7-1.1 cm]
Fractional shortening (FS): 32.8% [FS 34-44%]
Left ventricular posterior wall thickness in diastole (LVPWd): 1.0 cm [0.9-1.1 cm]
Heart rate (HR): 73.0 BPM [60-100 BPM]
Cardiac output (CO, Teich): 7.3 l/min [2.5-7.2 l/min]
Doppler Measurements & Calculations:
Aortic valve maximum velocity (Ao V2 max): 84.2 cm/sec
Left ventricular maximum velocity (LV V1 max) PG: 2.4 mmHg
Aortic maximum pressure gradient (Ao max PG): 2.8 mmHg

Mr. Wang, 20~29 year old female. Ask Date: 2021/11/27

Dr. He Dongjin reply Cardiology

Hello, there's no need to worry about frequent early contractions.
As long as they last for more than 20 occurrences, based on the data you provided, they are still within the normal and acceptable range.
This means they are normal and not associated with a higher risk of sudden cardiac death compared to others.
Don't overthink it; just live your life well and coexist peacefully with it.
Changhua Hospital cares about you.

Reply Date: 2021/11/27

More Info

Atrial Premature Contractions (APCs) are a common type of arrhythmia characterized by early heartbeats originating in the atria. Understanding the causes, symptoms, and management of APCs is crucial for patients experiencing these irregularities, especially when they are accompanied by other cardiac conditions.

Causes of Atrial Premature Contractions
APCs can be triggered by various factors, including:
1. Electrolyte Imbalances: Abnormal levels of potassium, magnesium, or calcium can lead to increased excitability of the heart muscle.

2. Stimulants: Caffeine, nicotine, and certain medications can provoke APCs.

3. Stress and Anxiety: Emotional stress can increase sympathetic nervous system activity, leading to arrhythmias.

4. Underlying Heart Conditions: Structural heart diseases, such as mitral valve prolapse (MVP) or heart failure, can predispose individuals to APCs.

5. Increased Physical Activity: As you noted, exercise can sometimes trigger APCs, particularly if the heart is under stress or if there are underlying issues.

Symptoms of Atrial Premature Contractions
Many individuals with APCs may not experience any symptoms. However, when symptoms do occur, they can include:
- Palpitations or the sensation of a skipped heartbeat.

- Anxiety or a feeling of unease.

- Dizziness or lightheadedness in some cases, especially if the APCs are frequent.

Management of Atrial Premature Contractions
1. Lifestyle Modifications: Reducing caffeine and alcohol intake, managing stress through relaxation techniques, and ensuring adequate hydration can help minimize APCs.

2. Medication: In cases where APCs are frequent or symptomatic, medications such as beta-blockers may be prescribed to help regulate heart rhythm.

3. Monitoring: Continuous monitoring through Holter monitors or event recorders can help assess the frequency and pattern of APCs, guiding treatment decisions.

4. Follow-Up: Regular follow-ups with a cardiologist are essential, especially if there are changes in the frequency or nature of the APCs.

Addressing Your Concerns
1. Is This Worsening?: The increase in frequency of your APCs could be due to various factors, including stress, changes in medication, or even the natural variability of arrhythmias. It does not necessarily indicate a worsening of your condition, but it is essential to discuss these changes with your cardiologist.

2. Further Testing: Given your history of mitral valve prolapse and mild regurgitation, it may be beneficial to have further evaluations, such as an echocardiogram or a stress test, to assess your heart's function and structure.

3. Managing Frequent APCs: If you experience frequent APCs during exercise, it is advisable to stop the activity and rest. If symptoms persist or worsen, seek medical attention.

4. Why the Sudden Increase?: The sudden increase in APCs can be attributed to various factors, including stress, changes in medication, or even seasonal variations. It is crucial to monitor these changes and communicate them to your healthcare provider.

Conclusion
While APCs can be concerning, they are often benign, especially in individuals without significant underlying heart disease. However, your feelings of anxiety and distress are valid, and it is essential to address these with your healthcare provider. They can offer reassurance, adjust your treatment plan, and provide strategies to manage both the physical and emotional aspects of living with APCs. Remember, you are not alone in this, and support is available.

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