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Suggest Treatment For Irregular Heart Beats
Question: I have irregular heart beats. I am followed by cardiologist. My next appointment is in 9 months. Most of the time when i feel the feeling of flip flop and flatter, i have been explained that i have an extra beat which does not need treatment. However after placing a heart monitor under skin, my cardiologist discovered that i have had once a month also atrial fribillation. I am taking aspirin and metoprolol at the moment. My questions are: is there anyway i can know the difference of the 2 conditions when i feel the flip flop in my chest? Are these medication enough to reduce the risks even if i am having AF? When having the sensations should i just let pass? In which case should i seek help?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
Regarding your concern, I would like to explain that it is often difficult to differentiate between apisodic atrial fibrillation and isolated ectopic heart beats only by judging palpitations feeling.
Sometimes paroxysmal atrial fibrillation are completely asymptomatic, other times ectopic heart beats may give considerable unpleasant feeling (palpitations and discomfort) that may be misunderstood for a complex arrhythmic event (like atrial fibrillation, short run of atrial tachycardia, etc).
Nevertheless, as a general rule if atrial fibrillation is not asymptomatic, it may be presented with sustained irregular heartbeats (usually faster than the basal normal sinus rhythm).
If those feeling of palpitations become frequent and disturbing my advice is to seriously consider consulting with your attending cardiologist for a new review of the clinical status and possibly optimization of therapy.
Whether taking just an antiagregant like Aspirin or anticoagulation instead, will depend on the score risk for embolic events imposed by the potential presence of atrial fibrillation.
Such a score, as CHA2 DS2- VASC score should be less than 2 to denote a low or intermediate risk for experienxing a stroke in this regard.
As you are a 60 years old female you may have a score of around 1; so Aspirin seems to be suitable for you.
BUT, if you have a history of congestive heart failure, hypertension, diabetes mellitus, vadcular disease, or history of previous stroke or thromboembolism, then your CHA2DS2-VASC score is higher than 2 and you need anticoagulation as you are in considerable risk of embolic events.
So could you provide me with more information about the above mentioned clinical topics (hypertension, diabetes, etc).
Regarding the most appropriate antiarrhythmic regimen to follow, it is necessary to investigate for the right etiological cause of those arrhythmic events, as treating the cause yield the best outcomes for prevention of future complications.
For this reason, besides the ambulatory ECG monitoring you have already done, I would recommend:
- Cardiac ultrasound (to exclude an underlying cardiomyopathy),
- Thyroid function test (for a possible dysfunction),
- Chest X ray an pulmonary function tests (for ruling out pulmonary dysfunction)
- Renal and adrenal function tests (which may trigger cardiac arrhythmia by producing underlying electrolytic imbalances)
- Complete blood count (to rule out anemia)
- Cardiac stress test (to rule out an underlying ischemic heart disease)
- Fasting glucose and HbA1c (to rule out diabetes and glucose metabolism impairment),etc
Identifying the exact etiological factor could lead to an optimal therapy for suppression of cardiac arrhythmia.
As far as you have haven’t an obvious cardiomyopathy, and the above tests result normal, Metoprolol seems to be one of the acceptable therapeutic options.
As, I explained you above, if those arrhythmic episodes feeling become sustained (are not isolated episodes or appears very frequent) and produce important complains (chest discomfort, dyspnea, etc), this would be the right case to seek medical attention by the ER doctor or your cardiologist.
Hope to have been helpful to you!
If you have further uncertainties, do not hesitate to ask me!
Best regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
Regarding your concern, I would like to explain that it is often difficult to differentiate between apisodic atrial fibrillation and isolated ectopic heart beats only by judging palpitations feeling.
Sometimes paroxysmal atrial fibrillation are completely asymptomatic, other times ectopic heart beats may give considerable unpleasant feeling (palpitations and discomfort) that may be misunderstood for a complex arrhythmic event (like atrial fibrillation, short run of atrial tachycardia, etc).
Nevertheless, as a general rule if atrial fibrillation is not asymptomatic, it may be presented with sustained irregular heartbeats (usually faster than the basal normal sinus rhythm).
If those feeling of palpitations become frequent and disturbing my advice is to seriously consider consulting with your attending cardiologist for a new review of the clinical status and possibly optimization of therapy.
Whether taking just an antiagregant like Aspirin or anticoagulation instead, will depend on the score risk for embolic events imposed by the potential presence of atrial fibrillation.
Such a score, as CHA2 DS2- VASC score should be less than 2 to denote a low or intermediate risk for experienxing a stroke in this regard.
As you are a 60 years old female you may have a score of around 1; so Aspirin seems to be suitable for you.
BUT, if you have a history of congestive heart failure, hypertension, diabetes mellitus, vadcular disease, or history of previous stroke or thromboembolism, then your CHA2DS2-VASC score is higher than 2 and you need anticoagulation as you are in considerable risk of embolic events.
So could you provide me with more information about the above mentioned clinical topics (hypertension, diabetes, etc).
Regarding the most appropriate antiarrhythmic regimen to follow, it is necessary to investigate for the right etiological cause of those arrhythmic events, as treating the cause yield the best outcomes for prevention of future complications.
For this reason, besides the ambulatory ECG monitoring you have already done, I would recommend:
- Cardiac ultrasound (to exclude an underlying cardiomyopathy),
- Thyroid function test (for a possible dysfunction),
- Chest X ray an pulmonary function tests (for ruling out pulmonary dysfunction)
- Renal and adrenal function tests (which may trigger cardiac arrhythmia by producing underlying electrolytic imbalances)
- Complete blood count (to rule out anemia)
- Cardiac stress test (to rule out an underlying ischemic heart disease)
- Fasting glucose and HbA1c (to rule out diabetes and glucose metabolism impairment),etc
Identifying the exact etiological factor could lead to an optimal therapy for suppression of cardiac arrhythmia.
As far as you have haven’t an obvious cardiomyopathy, and the above tests result normal, Metoprolol seems to be one of the acceptable therapeutic options.
As, I explained you above, if those arrhythmic episodes feeling become sustained (are not isolated episodes or appears very frequent) and produce important complains (chest discomfort, dyspnea, etc), this would be the right case to seek medical attention by the ER doctor or your cardiologist.
Hope to have been helpful to you!
If you have further uncertainties, do not hesitate to ask me!
Best regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for this has been very helpful. Just to add up, I have had couple of times stress test and also recently an echo test. Both was normal. I believe on my routine tests glucose has been done and was normal. My blood count also has been normal. However i have been diagnosed with toxic thyroid nodule and have hyperthyroidism. And just started medication for it. I will follow up on chest x rayrenal and adrenal function tests. Thank you again
Brief Answer:
You are welcome!
Detailed Answer:
Hello again,
It seems that a possible thyroid dysfunction may be responsible for your recurrent arrhythmia. As hyperthyroidism needs a longstanding treatment, you should be in close contact with your endocrinologist (checking periodically thyroid function tests and other recommended exams).
I wish everything will be under control after starting thyroid therapy.
If you have any further uncertainties, do not hesitate to contact me!
Best wishes,
Dr. Iliri
You are welcome!
Detailed Answer:
Hello again,
It seems that a possible thyroid dysfunction may be responsible for your recurrent arrhythmia. As hyperthyroidism needs a longstanding treatment, you should be in close contact with your endocrinologist (checking periodically thyroid function tests and other recommended exams).
I wish everything will be under control after starting thyroid therapy.
If you have any further uncertainties, do not hesitate to contact me!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for all you feedbacks very helpful. Haven't had opportunity to contuct further test as yet but was wondering if you could clarify this for me, one of my on going symptoms is the feeling of thightness around head and neck, light headedness and nausea could this be associate with aterial fibrillation, or even those isolated ectopic heart beats? Or other wise related to my thyroid problem? At times when becomes very problemetic i take a tablet for migraine and nausea such as anagraine and it get better for few hours but it comes back. And usually sets for few days. Thank you and Warmestregards
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello again!
I understand your concern and would explain that your symptoms don't seem to be related to ectopic heart beats.
Your symptoms seem to be caused by migraine or tensive type headache.
The pressure like, tightness around head and neck are usually typical of tensive type headache.
While nausea is usually accompanying migraine. The duration up to some days is also in favor of migraine.
A thyroid dysfunction is known to exacerbate both these types of headache.
Besides, a cervical spondylarthrosis (chronic degenerations of the cervical column) could also trigger this type of headache.
I recommend consulting with a neurologist for a careful physical examination and a cervical column X ray study to exclude possible spondylarthrosis.
You should also perform the thyroid function tests (thyroid hormone levels) to rule in/out this possible disorder.
Hope to have been helpful!
Greetings!
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello again!
I understand your concern and would explain that your symptoms don't seem to be related to ectopic heart beats.
Your symptoms seem to be caused by migraine or tensive type headache.
The pressure like, tightness around head and neck are usually typical of tensive type headache.
While nausea is usually accompanying migraine. The duration up to some days is also in favor of migraine.
A thyroid dysfunction is known to exacerbate both these types of headache.
Besides, a cervical spondylarthrosis (chronic degenerations of the cervical column) could also trigger this type of headache.
I recommend consulting with a neurologist for a careful physical examination and a cervical column X ray study to exclude possible spondylarthrosis.
You should also perform the thyroid function tests (thyroid hormone levels) to rule in/out this possible disorder.
Hope to have been helpful!
Greetings!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Very helpful thank you so much
Brief Answer:
You are welcome!
Detailed Answer:
Feel free to ask me in case of further uncertainties.
Best regards,
Dr. Iliri
You are welcome!
Detailed Answer:
Feel free to ask me in case of further uncertainties.
Best regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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