Premature Heartbeats

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | Patient Advice

Definition

Premature Heartbeats, also known as ectopic beats, are early or extra heartbeats that disrupt the regular heart rhythm. They can occur in the upper chambers (atria) or lower chambers (ventricles) of the heart.

Aetiology

Common causes of premature heartbeats include:

• Normal Variant: Commonly occur in healthy individuals without underlying heart disease.
• Stress or Anxiety: Emotional distress can trigger ectopic beats.
• Stimulants: Excess caffeine, alcohol, or nicotine use.
• Electrolyte Imbalances: Abnormal potassium or magnesium levels.
• Underlying Heart Disease: Conditions such as coronary artery disease or heart failure.
• Medications: Certain drugs, such as beta-agonists or digoxin.

Pathophysiology

Premature heartbeats arise from abnormal electrical activity in the heart:

• Atrial Premature Beats (APBs): Ectopic electrical signals originating from the atria cause early contractions.
• Ventricular Premature Beats (VPBs): Abnormal electrical signals from the ventricles bypass the normal conduction pathway.
• These extra beats disrupt the timing of normal heart rhythms and may be followed by a pause (compensatory pause).

Risk Factors

Factors that increase the likelihood of premature heartbeats include:

• High levels of stress or anxiety.
• Excessive intake of stimulants (caffeine, nicotine, alcohol).
• Existing heart conditions such as cardiomyopathy or coronary artery disease.
• Electrolyte disturbances, e.g., low potassium or magnesium.
• Ageing, as irregular beats are more common in older adults.

Signs and Symptoms

Symptoms of premature heartbeats include:

• Palpitations: Sensation of skipped or extra beats.
• Fluttering in the Chest: Awareness of abnormal heart rhythm.
• Fatigue: Due to inefficient blood pumping in persistent cases.
• Lightheadedness: Rarely, if the beats disrupt blood flow significantly.
• Asymptomatic: Most people experience no symptoms.

Investigations

Tests to diagnose premature heartbeats include:

• Electrocardiogram (ECG): Identifies premature atrial or ventricular contractions and their timing.
• 24-hour Holter Monitor: Records heart rhythm over 24 hours to capture intermittent ectopic beats.
• Electrolyte Panel: Identifies abnormalities in potassium or magnesium levels.
• Echocardiography: Assesses heart structure and function to rule out underlying heart disease.
• Stress Test: Determines if ectopic beats are exercise-induced.

Management

1. Lifestyle Modifications

• Reduce Stimulants: Limit caffeine, alcohol, and nicotine intake.
• Stress Management: Techniques such as mindfulness or relaxation exercises can reduce triggers.
• Balanced Diet: Maintain adequate potassium and magnesium levels through diet.

2. Medical Management

• Beta-blockers: Medications like bisoprolol may reduce ectopic beats and symptoms, particularly if frequent.
• Antiarrhythmics: In rare cases, drugs such as flecainide are used under specialist guidance.

3. Referral to Specialist

Referral to secondary care is required if:

• Premature heartbeats are frequent and symptomatic.
• There is evidence of underlying heart disease or structural abnormalities.
• An electrophysiological study (EPS) may be performed to localise and treat the abnormal electrical pathways.
• Catheter ablation is considered for symptomatic ventricular ectopic beats that are refractory to medical therapy.

Patient Advice

Key advice includes:

• Limit caffeine, alcohol, and nicotine intake to reduce triggers.
• Maintain a healthy, balanced diet rich in fruits and vegetables.
• Engage in regular exercise but avoid overexertion.
• Seek medical advice if palpitations become frequent or are associated with dizziness or chest pain.

References

1. National Institute for Health and Care Excellence (NICE) (2024). Management of Arrhythmias. Available at: https://www.nice.org.uk (Accessed: 30 December 2024).
2. British Heart Foundation (BHF) (2024). Palpitations and Ectopic Beats. Available at: https://www.bhf.org.uk (Accessed: 30 December 2024).