Premature Beats: Causes, Treatment, and Management Tips

Early beat issues, please help answer, thank you?

Hello, Doctor.
I would like to inquire about my recent experience with frequent premature ventricular contractions (PVCs).
On the first day, I had over 1000 PVCs, and in the following days, it decreased to 500, 400, 300, and even none at times.
My doctor switched my medication to take one tablet of Concor (1.25 mg) in the morning and one in the evening, along with propafenone hydrochloride (150 mg tablets).
Sometimes, I may go one or two weeks without PVCs, but there are times when I experience them for 2-3 consecutive days.
Recently, I have had 1-2 PVCs each day (for example: Monday 2 PVCs, Tuesday 1 PVC, Wednesday 2 PVCs).

1.
What could be the reasons for the occurrence of PVCs? Could it be due to weather changes, diet, or sleep?
2.
Is it possible that my medication dosage is too low? Should I consider increasing the propafenone to three times a day?
3.
Can weight loss help reduce the occurrence of PVCs? Should I strive to reach a normal weight? I previously weighed 103 kg and had several weeks without PVCs, but I have recently gained 3-4 kg and started experiencing PVCs again (about 5-6 occurrences a week, roughly 1-2 each day).
4.
If I undergo catheter ablation, is there a chance for a complete cure? If successful, is there a possibility of recurrence?
5.
Why do I feel my PVCs so intensely, while some people can have thousands without noticing?
6.
I am regularly taking medication for anxiety, depression, and sedatives.
Can these help in treating autonomic nervous system issues?
7.
Could fatty liver potentially cause PVCs?
Thank you for your assistance, Doctor!

A-Chang, 20~29 year old female. Ask Date: 2022/04/25

Dr. He Dongjin reply Cardiology

Hello, what are the reasons that can lead to premature beats? To be honest, factors such as weather changes, diet, and sleep can all contribute.
If premature beats are severe during this period, can changing to three meals a day help reduce their occurrence? I don't believe that undergoing catheter ablation will provide a permanent cure, but it may reduce the frequency, although recurrence is possible.
Why do you feel your premature beats? It should be related to your anxiety and the stability of your autonomic nervous system.
Regular use of anxiety medication can help stabilize the autonomic nervous system.
Could fatty liver potentially cause premature beats? I don't think that Changhua Hospital is particularly concerned about you.

Reply Date: 2022/04/25

More Info

Premature beats, also known as premature ventricular contractions (PVCs) or premature atrial contractions (PACs), are common cardiac arrhythmias that can cause significant concern for patients. Understanding the causes, treatment options, and management strategies is crucial for those experiencing these irregular heartbeats.

Causes of Premature Beats
1. Lifestyle Factors: Various lifestyle factors can contribute to the occurrence of premature beats. Stress, anxiety, and fatigue are significant triggers. Your mention of anxiety and depression medications suggests that your emotional state could be influencing your heart rhythm. Additionally, excessive caffeine, alcohol, and nicotine intake can also provoke these irregularities.

2. Diet and Hydration: Dehydration or electrolyte imbalances (such as low potassium or magnesium levels) can lead to increased cardiac irritability. A well-balanced diet and adequate hydration are essential for maintaining normal heart function.

3. Sleep Patterns: Poor sleep quality or sleep deprivation can exacerbate arrhythmias. Ensuring you have a regular sleep schedule and adequate rest can help mitigate these episodes.

4. Medical Conditions: Underlying health issues, such as thyroid disorders, hypertension, or structural heart disease, can also lead to premature beats. Your mention of fatty liver disease could be relevant, as liver dysfunction can affect overall metabolism and potentially influence heart rhythm.

Treatment and Management
1. Medication Adjustments: You are currently on Concor (bisoprolol) and Propafenone, which are both effective in managing arrhythmias. If you are experiencing breakthrough premature beats, it is essential to discuss with your physician whether the dosage needs adjustment. Increasing Propafenone to three times a day may be beneficial, but this should only be done under medical supervision.

2. Weight Management: Weight loss can significantly impact heart health. Reducing excess weight may decrease the frequency of premature beats, as obesity is associated with increased cardiac workload and potential arrhythmias. Aiming for a healthy weight through diet and exercise can be a proactive approach.

3. Electrophysiological Study and Ablation: If your premature beats are frequent and symptomatic, an electrophysiological study may be warranted. This procedure can identify the source of the arrhythmia and potentially allow for catheter ablation, which can provide a long-term solution. However, the success rate varies, and there is a possibility of recurrence.

4. Monitoring and Follow-Up: Regular follow-up with your healthcare provider is essential. Keeping a diary of your symptoms, including the frequency and circumstances surrounding your premature beats, can help your doctor tailor your treatment plan effectively.

5. Managing Anxiety and Stress: Since you are on medications for anxiety and depression, it is crucial to continue addressing these issues. Stress management techniques, such as mindfulness, yoga, or cognitive behavioral therapy, can help reduce the frequency of premature beats.

Sensitivity to Premature Beats
The perception of premature beats varies among individuals. Some people may feel every single irregular heartbeat, while others may not notice them at all. This can be influenced by individual sensitivity, anxiety levels, and overall awareness of bodily sensations.

Conclusion
In summary, premature beats can be multifactorial, influenced by lifestyle, emotional state, and underlying health conditions. It is essential to work closely with your healthcare provider to adjust medications, manage weight, and address any contributing factors. Regular monitoring and a proactive approach to lifestyle changes can significantly improve your quality of life and reduce the frequency of these arrhythmias. If you have further concerns or if your symptoms worsen, do not hesitate to seek immediate medical attention.

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