Early Contractions and Sudden Heart Rate Spikes

Premature contractions lead to sudden tachycardia?

Hello, I previously experienced episodes of sudden and forceful heartbeats that made me uncomfortable.
After these episodes became more frequent, I consulted a doctor and was diagnosed with premature contractions.
My first 24-hour Holter ECG report showed the following:
1.
The baseline ECG showed sinus rhythm with a rate of 46-112 beats per minute.
The average heart rate was 71 beats per minute.

2.
There was sinus bradycardia without long pauses.

3.
No paroxysmal supraventricular tachycardia (PSVT), paroxysmal atrial fibrillation (PAF), ventricular tachycardia (VT), or ventricular fibrillation (VF) were observed.

4.
There were a few premature ventricular contractions (PVCs) totaling 42 beats, and premature atrial contractions (PACs) totaling 8 beats during the examination period.

5.
No significant patient events were noted.
The doctor prescribed me a medication called Sinacore, which I took continuously, and it improved my condition.
I later switched to taking it only when I felt uncomfortable (which was just a sudden irregular heartbeat), and I did not experience discomfort for six months.
However, the symptoms returned, though they were not severe or frequent.

Later on, I began to experience episodes where, without warning (while doing nothing), I felt slightly short of breath, my upper body felt numb and tight, my heart rate suddenly increased as if I had just finished running, and my hands and feet began to tremble.
This would last for about five minutes before it started to calm down, but then the heart rate would accelerate again, and the shaking would resume (with the same symptoms), occurring about 3 to 4 times, repeating for about an hour.
Afterward, I would feel sore and weak all over, and sometimes my muscles would twitch (previously, the twitching was intermittent and was diagnosed as benign fasciculation).
Due to these sudden episodes of increased heart rate and difficulty breathing, I visited the emergency room three times (including once in the middle of the night).
During one of these visits, I was hospitalized and underwent an echocardiogram.
The report indicated:
Atrium and Aortic Root
- Aortic Diameter (AO): 31 mm
- Left Atrial Diameter (LA): 26 mm
Left Ventricle
- Interventricular Septum (IVS): 7 mm
- Posterior Wall (PW): 6 mm
- End-Diastolic Diameter (EDD): 39 mm
- End-Systolic Diameter (ESD): 25 mm
- Left Ventricular Ejection Fraction (LVEF) by M-mode measurement: 66%
Valves
- Mitral Stenosis (MS): None
- Mitral Regurgitation (MR): None
- Aortic Stenosis (AS): None
- Aortic Regurgitation (AR): None
- Tricuspid Stenosis (TS): None
- Tricuspid Regurgitation (TR): None
- Pulmonary Stenosis (PS): None
- Pulmonary Regurgitation (PR): None
Conclusion:
- Rhythm and Appearance: Sinus rhythm
- Left Ventricle:
- Systolic function: Normal
- Wall motion: Normal
- Diastolic function: Normal
- Right Ventricle:
- Systolic function: Normal
However, no specific issues were identified during the examinations, and the doctor indicated that there was no need for an electrophysiological study.
Each time I experienced an episode, I wondered whether I should go to the emergency room or if not going would be life-threatening, especially since I already have premature contractions.

I would like to know if these symptoms could have any impact on my heart, given that every examination has indicated that everything is fine.
I feel somewhat helpless.
Additionally, if I experience a sudden episode again, is it safe to take the heart rhythm medication?
My second 24-hour Holter report showed the following:
Code No.: LHA110-1124
Clinical Diagnosis: Cardiac arrhythmia
Test Date: 2021/6/23
Analysis Date: 2021/6/24
Hookup Time: 11:41
Recording Time: 23 hours 57 minutes
Analysis Time: 23 hours 57 minutes
Analysis Result:
- Technical quality of record: Good
- Dominant rhythm: Sinus
- Total Beats: 101,016
- Minimum Heart Rate: 49 BPM at 00:49:29
- Average Heart Rate: 72 BPM
- Maximum Heart Rate: 120 BPM at 08:17:05
Heart Rate Variability:
- ASDNN 5: 67.1 msec
- SDANN 5: 95.3 msec
- SDNN: 117.7 msec
- Atrial Fibrillation (AFib) Beats: 0 (0.0%)
- AFib Duration: 0.0 min
PVCs/couplets/triplets/VT: 0/0/0
PACs/couplets/AT: 2/0/0
Fastest: 0 BPM
Drop (delay > 2.0 sec)/Late: 0/3
Longest N-N: 1.3 sec at 05:24:06
Others:
- Comments:
- Sinus rhythm with a rate ranging from 49-120 BPM and a mean of 72 BPM.

- 2 premature atrial beats
- No AV block
- No significant long pauses
Additionally, during a health check, a small thyroid nodule was discovered, but thyroid function tests were normal, so I am unsure what the underlying issue is that causes these symptoms.
I am very afraid of sudden cardiac death.
If my heart examinations are normal, should I consider consulting other specialties? Thank you for your response.

Dou Dou, 30~39 year old female. Ask Date: 2022/11/10

Dr. Wu Xueming reply Cardiology

Many factors in daily life can contribute to this situation, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages.
It is recommended to adjust your daily routine and engage in regular exercise.

Reply Date: 2022/11/10

More Info

Understanding early contractions and sudden heart rate spikes can be quite concerning, especially when they manifest as symptoms like palpitations, shortness of breath, or anxiety. Based on your detailed description, it seems you have experienced episodes of premature contractions, specifically premature ventricular contractions (PVCs) and premature atrial contractions (PACs), which are generally benign but can cause significant anxiety and discomfort.

Overview of Your Condition
1. Premature Contractions: PVCs and PACs are common arrhythmias that occur when the heart's electrical system misfires, causing an early heartbeat. While they can be alarming, especially when accompanied by symptoms like a racing heart or difficulty breathing, they are often not indicative of serious heart disease in otherwise healthy individuals.

2. Heart Rate Variability: Your Holter monitor results indicate a normal sinus rhythm with a heart rate ranging from 49 to 120 beats per minute. This variability is typical and can be influenced by factors such as physical activity, stress, and even sleep patterns. The presence of a few PVCs and PACs is not uncommon and, in your case, does not seem to correlate with any significant heart disease.

3. Symptoms of Anxiety: The episodes of feeling short of breath and having a racing heart could be exacerbated by anxiety, especially given your history of panic attacks. Anxiety can trigger the sympathetic nervous system, leading to increased heart rate and sensations of breathlessness. This is often mistaken for a cardiac event, which can further heighten anxiety.

Recommendations for Management
1. Monitoring and Medication: It’s good that you have been prescribed medication (likely a beta-blocker) to manage your symptoms. These medications can help reduce the frequency of PVCs and PACs and alleviate anxiety. If you experience sudden spikes in heart rate or palpitations, taking your prescribed medication as needed is appropriate. However, always consult your doctor before making any changes to your medication regimen.

2. Lifestyle Modifications: Regular exercise, as you have started with jogging, can significantly improve cardiovascular health and reduce anxiety. Aim for at least 150 minutes of moderate aerobic activity each week. Additionally, practicing relaxation techniques such as deep breathing, yoga, or mindfulness can help manage anxiety and its physical manifestations.

3. Follow-Up with Healthcare Providers: Since you have had multiple evaluations that have shown no significant heart disease, it may be beneficial to discuss your symptoms with a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly effective for managing anxiety and panic disorders.
4. Further Investigations: If your symptoms persist or worsen, it may be worth discussing further evaluations with your healthcare provider. This could include assessments for other potential causes of your symptoms, such as thyroid function tests (given your mention of thyroid nodules) or even a referral to a cardiologist for a more detailed evaluation if necessary.

5. Emergency Situations: If you ever feel that your symptoms are severe or if you experience chest pain, severe shortness of breath, or fainting, do not hesitate to seek emergency medical attention. It’s always better to err on the side of caution.

Conclusion
In summary, while your episodes of early contractions and sudden heart rate spikes can be distressing, the evidence from your tests suggests that they are likely benign, especially in the absence of significant heart disease. Managing anxiety, maintaining a healthy lifestyle, and staying in close communication with your healthcare providers will be key in navigating your symptoms. Remember, you are not alone in this, and many people experience similar issues that can be effectively managed with the right approach.

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