Frequent Early Contractions: Heart Health Risks and Concerns

Hello, doctor. Does frequent premature contractions harm the heart or the body? Do they increase the risk of stroke? I would like to inquire about the heart report?

Hello Doctor,
1.
Could you please tell me the severity of myocardial ischemia indicated in my heart report? Is it serious? Do I need surgery?
2.
Why has the frequency of early contractions increased from 8 per day to 12,426 over the past year and a half? Is this related to menopause, or could it be influenced by the medication I am taking?
3.
I am currently taking a heart rate medication, but I feel uncomfortable as my heart rate drops to between 45-70 bpm.
My heart was already uncomfortable, but the medication makes it worse.
Can I stop taking it?
4.
Can frequent early contractions harm the heart or body? Does it increase the risk of stroke?
Thank you.

Exercise ECG: The patient exercised according to the BRUCE protocol for 09:10 minutes, achieving a maximum MET level of 10.3.
The resting heart rate of 90 bpm rose to a maximal heart rate of 160 bpm, which represents 93% of the age-predicted maximum heart rate.
The resting blood pressure of 127/70 mmHg rose to a maximum of 136/75 mmHg.
The exercise test was stopped due to reaching the target heart rate (85-99% MHR), dyspnea, and fatigue.
Conclusion:
Resting ECG: PVCs
ST changes during TET: 1-mm horizontal ST-segment depression in leads II, III, AVF, and V5-6 during recovery phases.

Interpretation: Probably positive for ischemia.

Sinus rhythm with rare isolated atrial premature contractions (APCs), very frequent isolated ventricular premature contractions (VPCs), occasional VPC couplets, and rare episodes of short runs of ventricular tachycardia (longest: 3 beats).
No long pauses or significant tachyarrhythmias.

Heart ultrasound (Echocardiography) Report:
Clinical Diagnosis: CVA
2D transthoracic echocardiography
- Aortic diameter (AO): 29 mm
- Left atrial diameter (LA): 43 mm
- Interventricular septum thickness (IVS): 13 mm
- Left ventricular posterior wall thickness (LVPW): 9 mm
- Left ventricular end-diastolic diameter (LVEDD): 40 mm
- Left ventricular end-systolic diameter (LVESD): 20 mm
- Left ventricular end-diastolic volume (LVEDV): 68 ml
- Left ventricular end-systolic volume (LVESV): 13 ml
- Left ventricular mass: 137 gm
- Right ventricular end-diastolic diameter (RVEDD): Not specified
- Tricuspid annular plane systolic excursion (TAPSE): 24 mm
- Left ventricular ejection fraction (LVEF): 80% (M-mode Teichholz)
- 2D (M-Simpson): Diagnosis:
1.
Heart size: Dilated left atrium; ascending aorta (AsAo) 32 mm; (LA volume: 57 ml, LA volume index: 34.3 ml/m2)
2.
Thickening: IVS
3.
Pericardial effusion: None
4.
Normal left ventricular systolic function
5.
Normal right ventricular systolic function
6.
Normal left ventricular wall motion
7.
Mitral valve prolapse: None; Mitral stenosis: None; Mitral regurgitation: Trivial; Aortic stenosis: None; Max aortic valve velocity = 1.57 m/s; Aortic regurgitation: None; Aortic valve sclerosis: NCC, RCC, LCC; Tricuspid regurgitation: None; Tricuspid stenosis: None; Pulmonary regurgitation: Mild; Pulmonary stenosis: None
8.
Mitral E/A = 110 / 95 cm/s (E/A ratio = 1.16); Deceleration time = 206 ms; Heart rate = 79 bpm
9.
Septal mitral annular e' and a' = 8.4 / 12 cm/s; Septal E/e' = 13.1; Lateral mitral annular e' and a' = 10.8 / 14.8 cm/s; Lateral E/e' = 10.2
10.
No intracardiac thrombus
11.
No vegetation
12.
No congenital lesions
13.
No calcified lesions
14.
IVC size: 12 mm with inspiratory collapse >50%
Conclusion:
1.
Mild septal hypertrophy with indeterminate left ventricular filling pressure; mildly dilated left atrium.

2.
Normal left and right ventricular systolic function.

3.
Mild aortic valve sclerosis; trivial mitral regurgitation; mild pulmonary regurgitation.

4.
Mildly dilated proximal ascending aorta (32 mm).

24-hour ECG:
Sinus rhythm with rare isolated APCs, very frequent isolated VPCs, occasional VPC couplets, and rare episodes of short runs of ventricular tachycardia (longest: 3 beats).
No long pauses or significant tachyarrhythmias.

Miss Wang, 50~59 year old female. Ask Date: 2023/06/05

Dr. Wu Xueming reply Cardiology

1.
The positive predictive value of an exercise electrocardiogram is approximately 60 to 70 percent.
For a more accurate assessment of myocardial ischemia, a myocardial perfusion scan using isotopes can be performed.
2.
Many factors in daily life can contribute to this condition, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages.
It is recommended to adjust lifestyle habits and engage in regular exercise.
3.
The use of medications should be discussed with the prescribing physician in the outpatient clinic.
4.
No.

Reply Date: 2023/06/05

More Info

Understanding frequent early contractions, also known as premature ventricular contractions (PVCs) or premature atrial contractions (PACs), is crucial for assessing heart health and potential risks. Your concerns regarding the increase in these contractions, the implications of your heart health reports, and the associated anxiety are valid and deserve thorough exploration.

1. Severity of Myocardial Ischemia: The report indicating myocardial ischemia suggests that there are areas of the heart muscle that are not receiving adequate blood flow, which can be serious. The degree of severity can vary, and while it may not always necessitate surgical intervention, it does warrant close monitoring and possibly further diagnostic testing, such as a coronary angiogram, to evaluate the coronary arteries' condition. The presence of ischemia can lead to symptoms like chest pain or discomfort, and if left untreated, it may progress to more severe conditions like a heart attack.

2. Increase in Early Contractions: The significant rise in the frequency of early contractions from 8 per day to over 12,000 could be influenced by various factors, including hormonal changes associated with menopause, lifestyle factors (such as caffeine intake, stress, and sleep patterns), or the medications you are taking. It’s essential to discuss these changes with your healthcare provider, as they can help determine if the increase is benign or if it requires further investigation.

3. Medication Concerns: If you are experiencing discomfort with your current medication regimen, particularly if your heart rate drops significantly (to 45-70 bpm), it’s crucial to communicate this with your physician. They may consider adjusting your medication or exploring alternative treatments. Abruptly stopping medication without medical advice can be dangerous, especially if it’s intended to manage arrhythmias or other cardiovascular issues.

4. Risks Associated with Frequent Early Contractions: Generally, isolated PVCs or PACs are common and often benign, especially in individuals without underlying heart disease. However, a high frequency of these contractions can sometimes indicate an underlying issue, such as electrolyte imbalances or structural heart problems. While frequent early contractions are not directly linked to an increased risk of stroke, they can be associated with other cardiovascular conditions that may elevate stroke risk. Therefore, it’s essential to monitor these symptoms and discuss them with your healthcare provider.

5. Psychological Factors: Anxiety and stress can significantly impact heart health and may exacerbate the perception of heart symptoms. It’s not uncommon for individuals to experience heightened awareness of their heartbeats or to misinterpret normal variations in heart rhythm as concerning. Engaging in stress-reduction techniques, such as mindfulness, therapy, or regular physical activity, can be beneficial.
In summary, while frequent early contractions can be concerning, they are often manageable with appropriate medical guidance. It's essential to maintain open communication with your healthcare provider about your symptoms, medication side effects, and any lifestyle factors that may contribute to your condition. Regular follow-ups and possibly additional testing will help ensure that any potential issues are addressed promptly, allowing you to maintain your heart health effectively.

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