DR. ROACH:

I went to a walk-in clinic because I had chest pain. They did an EKG and saw extra beats (PVCs). They recommended I go to a cardiologist, and he put me on a heart monitor, which showed that I had 5,000 extra beats within 24 hours. He had me come back in two weeks and did an echocardiogram (heart muscles are perfect) and heart monitor (still extra beats). He did a stress test, and it was normal. He has no idea why I have extra beats. I have a feeling they have been going on for a long period of time, because when the nurse asked me if I could feel them while she was doing the echo, it felt like a flutter, and I had been feeling them for at least a year (I didn’t know what it was). He has me coming back to see him in three months. Can you give me some insight? — D.J.

ANSWER:

Premature beats are very common, almost universal, and come in two types: premature atrial beats (PACs) and premature ventricular beats (PVCs). These can happen in people with perfectly normal hearts, but your cardiologist did exactly the recommended tests, including an EKG, echocardiogram and stress test. This is to be sure your heart function and blood flow are normal. Since they are, you don’t need to do anything about it unless the fluttering sensation is bothering you. There are several mechanisms for PVCs. The electrical system of the heart can develop a kind of short-circuit, called a re-entry loop, which is the most common cause. Individual heart muscle cells also can trigger a premature beat. If you desire treatment, the usual treatment is a beta blocker, which can reduce symptoms. Other medications also are used. In cases where medications don’t work, radio waves can be used to stop the areas of the heart where the extra beats arise.

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