Atrial Premature Contractions: Causes and Concerns

Atrial premature contraction (APC)

Hello, I would like to ask the director about my diagnosis of atrial premature contractions (APCs) in September, where I experienced about 5 APCs per day.
I have been actively treated with Cartil (Cardil) twice daily.
On November 19, the doctor mentioned that I could start to reduce the dosage.
However, on the afternoon of November 26, I suddenly experienced frequent APCs, reaching over 20 times, even up to 30 times, whereas previously I only had 2-3 APCs.
I am very confused as to why there was such a sudden increase in frequency.
Is this an indication of worsening atrial premature contractions?
Additionally, on the night of November 27, I experienced APCs again, but this time with a new symptom: my pulse would alternate between fast and slow (rapidly beating 1-2-3-4 and then slowing down to 5-6).
Could this possibly indicate atrial fibrillation? Why has my condition, which was previously well-controlled, suddenly worsened?
The echocardiogram also indicated mitral valve prolapse and regurgitation.
What should I do, director? Is this a deterioration? Am I at risk of dying? I have been feeling very anxious and depressed, and I just want to end it all.

The echocardiogram report from September 10, 2021, concluded with the following findings:
- 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
- R-R interval: 0.82 sec
- Ao root diameter: 3.1 cm [2.0-3.8 cm]
- LVIDd: 5.8 cm [3.7-5.3 cm]
- ACS: 1.9 cm [1.6-2.6 cm]
- LVIDs: 3.9 cm [2.4-3.6 cm]
- LA dimension: 3.5 cm [1.9-4.0 cm]
- EDV (Teich): 166.6 ml [80-180 ml]
- ESV (Teich): 65.9 ml [16-83 ml]
- MV E-F slope: 17.3 cm/sec [8.0-15.0 cm/sec]
- EF (Teich): 60.4% [50-70%]
- IVSd: 1.0 cm [0.7-1.1 cm]
- FS: 32.8% [FS 34-44%]
- LVPWd: 1.0 cm [0.9-1.1 cm]
- Heart rate: 73.0 BPM [60-100 BPM]
- CO (Teich): 7.3 l/min [2.5-7.2 l/min]
- RWT: 0.22-0.42
Thank you.

Wang, 20~29 year old female. Ask Date: 2021/11/28

Dr. Wu Xueming reply Cardiology

Based on your symptoms, it is recommended to adjust your daily routine and engage in regular exercise.
However, if the symptoms persist, it is advisable to visit a hospital for a consultation, where a physician can adjust your medication.

Reply Date: 2021/11/28

More Info

Atrial Premature Contractions (APCs) are early heartbeats originating in the atria, which can lead to feelings of palpitations or irregular heart rhythms. Understanding the causes and concerns surrounding APCs is crucial for managing symptoms and addressing any underlying issues.

Causes of Atrial Premature Contractions
1. Electrolyte Imbalances: Abnormal levels of potassium, magnesium, or calcium can affect the heart's electrical system, leading to APCs.

2. Stimulants: Caffeine, nicotine, alcohol, and certain medications can increase the likelihood of APCs.

3. Stress and Anxiety: Emotional stress can trigger or exacerbate APCs, as the body’s fight-or-flight response can influence heart rhythm.

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

5. Increased Sympathetic Tone: Conditions that increase the sympathetic nervous system's activity, such as hyperthyroidism, can lead to more frequent APCs.

Concerns Regarding Frequent APCs
In your case, the sudden increase in the frequency of APCs from a few per day to over 20-30 times is concerning. While APCs are often benign, a significant increase in frequency can indicate changes in the heart's electrical stability. The presence of new symptoms, such as a pulse that alternates between fast and slow, raises the possibility of more serious arrhythmias, including atrial fibrillation (AFib). AFib is characterized by an irregular and often rapid heart rate that can lead to complications such as stroke or heart failure.

Evaluation and Management
1. Monitoring: It is essential to keep track of the frequency and pattern of APCs. A Holter monitor may be recommended to assess your heart rhythm over 24-48 hours.

2. Electrocardiogram (ECG): An ECG can help determine if the APCs are isolated or part of a more complex arrhythmia.

3. Echocardiogram: Since you have a history of mitral valve prolapse and mild regurgitation, regular echocardiograms can help monitor any changes in heart structure or function.

4. Medication Adjustment: If you are on medications like Cartil (Carvedilol), your doctor may consider adjusting the dosage or switching to another medication based on your symptoms and heart rhythm.

5. Lifestyle Modifications: Reducing caffeine and alcohol intake, managing stress through relaxation techniques, and ensuring adequate hydration and electrolyte balance can help reduce APC frequency.

Addressing Anxiety and Mental Health
Your feelings of anxiety and depression are valid, especially when experiencing heart-related symptoms. It is crucial to address these concerns with a healthcare professional. Cognitive-behavioral therapy (CBT) and relaxation techniques can be beneficial in managing anxiety related to health issues.

Conclusion
While APCs can be benign, the sudden increase in frequency and the presence of new symptoms warrant further evaluation. It is essential to communicate openly with your healthcare provider about your symptoms, concerns, and any changes in your condition. Regular follow-ups and appropriate management strategies can help you maintain a good quality of life and reduce anxiety related to your heart health. Remember, you are not alone in this, and support is available to help you navigate these challenges.

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