Good health is one of our most valuable assets, although people tend to overlook their own health until they get sick. A healthy body and mind can work wonders even through the toughest periods of our lives. But when the body doesn’t function quite right, routine tasks can become difficult to accomplish. More than ever, heart health is in the spotlight of doctors and wellness centers, as it is an actual global issue. Genetic predisposition, enhanced by poor lifestyle habits, may serve to worsen minor heart issues.
Premature Atrial Contractions (PACs) are heart rhythm disturbances that few people understand. Although it is usually a benign condition, it can be a marker of more serious problems to come. PACs tend to increase with age, and they be worsened by risk factors like being overweight, an elevated cholesterol levels, increased age, alcohol and nicotine consumption, and pregnancy.
What are Premature Atrial Contractions (PACs)?
A PAC is an abnormally early heartbeat that does not come from the normal electrical “pacemaker” of the heart, The PAC causes the heart to contract earlier than it should. It is one type of cardiac arrhythmia that originates from the heart muscle in the top chambers or atria.
A normal resting heart rate for adults is anywhere from 60 to 80 beats per minute (bpm), depending on age, level of fitness, and genetics. Therefore, the normal heart beats approximately once every second. The heart beat arises from a specialized structure in the top of the right atrium. This electrical structure is known as the sinus node or sinoatrial node, and it generates a signal that starts each heart beat. All of the atrial muscle cells are capable of generating an electrical impulse. If a spot in the atrium decides to “fire” prematurely, it overrides the sinus node and causes the heart beat to occur early, effectively shortening the time in between beats. This can give rise to symptoms like palpitations, fluttering or flipping of the heart, or give the sense that the heart “skipped” a beat. It may occur on rare occasions or it can keep happening over and over for hours at a time.
Along with Premature Ventricular Contractions (PVCs), PACs are some of the most common arrhythmia conditions. Fortunately, they generally don’t directly pose a health risk and don’t require any specific treatment provided that the symptoms are tolerable.
How Is the Condition Diagnosed?
Patients with PACs may have any number of the following symptoms:
- A thump or jumping feeling in the chest
- Periodic fluttering like a butterfly in the chest
- Fatigue after moderate physical activity
- Dizziness / lightheadedness
- The recurrent feeling that their heart skipped a beat
- Rarely, fleeting chest pain with the feeling of a pause in the rhythm
When the heart skips a beat, the very next beat can come a little later and is sometimes felt more intensely. In some patients, that next beat can be more uncomfortable than the premature one. However, PACs frequently occur without any symptoms at all, and are picked up by chance on an electrocardiogram (ECG or EKG).
If you see your doctor with any of the above complaints, you will likely have an ECG done in the office. PACs are easy to see on an ECG, but only if you are having them at the time of the test. People can’t make them happen, and ironically the ECG often looks normal in the doctor’s office because the PACs are not happening at that moment.
Most of the time, if your symptoms are determined to be from PACs no further testing is necessary. Reassurance is the only recommended treatment in most cases. However, if the physical examination seems abnormal or if there are other signs and symptoms of significant heart disease (like a heart murmur or a significantly elevated blood pressure reading), you may be advised to undergo additional testing. You may even be referred to a cardiologist (heart specialist). Appropriate testing may include:
- A stress test, where your ECG will be performed while you walk on a treadmill to see if there is evidence of more serious heart arrhythmias or perhaps a suggestion of coronary artery disease.
- An echocardiogram, which tests the functioning of the heart valves and muscles. The moving, pumping heart is visualized on a computer screen by using sound waves (ultrasound waves, to be more precise).
In severe cases, where the symptoms are very bothersome for the patient, the doctor may recommend that the patient wear a heart monitor. This may also be done if the symptoms suggest an arrhythmia like PACs but nothing shows up on the ECG. A heart monitor is a portable device that records the heartbeats for 24 hours or longer if necessary. It provides the doctor with a long-term picture of the heart rhythm disturbance, and offers a clearer picture of the severity of the problem than an ECG. A monitor may also reveal other more serious arrhythmias like atrial fibrillation in older patients with severe symptoms of rapid, irregular heart beating.
What is the Best Approach For Premature Atrial Contractions?
PACs are extremely common and benign, but they can become annoying to the point where people feel it could be a major health issue. Luckily, PACs are not likely to degenerate into something worse. In some cases, they can indicate an underlying medical or cardiac problem. To avoid continued symptoms or possible problems in the future, it’s reasonable to investigate and address any possible underlying medical conditions. This can be done by your primary care doctor. Sometimes, blood tests are recommended, especially if you are already on medications. If you wear a monitor in order to get a handle on exactly how many PACs you might be having, keep in mind that having some PACs is normal and does not need to be treated. However, if you are having thousands of them all day every day, and they cause unrelenting, intolerable symptoms, then medical therapy might be considered as an option. In that case, you might want to have a consultation with a heart rhythm specialist (cardiac electrophysiologist) who can give you expert advice and offer you the widest range of options for treatment. Sometimes, in fact, the specialist may recommend no treatment at all, but the education and reassurance can be invaluable to the patient.
If the PAC symptoms are very bothersome to the patient, a doctor can prescribe antiarrhythmic medication like beta blockers or calcium blockers. Beta blockers work by blocking the effect of adrenaline (epinephrine) on the heart. Adrenaline is produced by the nervous system and the adrenal gland and is released in times of stress or with physical exertion. Adrenaline causes the heart to beat faster and stronger, and sometimes the spot in the top chamber that causes the PACs may be excessively sensitive to your own adrenaline, so it may fire more often. Beta blockers reduce that stimulatory effect on the heart by blocking adrenaline and can sometimes reduce the symptoms of PACs.
Calcium channel blockers like verapamil and diltiazem are used to affect the electrical currents in the heart and may directly reduce the number of PACs a person may have. Stronger antiarrhythmic medications are available, but you should definitely speak with an electrophysiologist before starting any medication like that.
Medications used to treat PACs can give rise to adverse effects like fatigue, lightheadedness, low blood pressure, headaches, flushing, ankle swelling or constipation. Since the PACs do no harm, the doctor needs to justify exposing a patient to those potential side effects before prescribing a pill for PACs. Symptoms have to be pretty bad before it’s worth taking medications for this benign arrhythmia.
Most doctors will recommend lifestyle changes, which can reduce PACs. Cutting back on caffeine, quitting smoking, and eating right can go a long way to alleviate the symptoms of PACs. Sometimes, the symptoms of PACs can be reduced significantly by the use of dietary supplements like magnesium (patients with severe kidney disease should not take large doses of magnesium).
As in any other disease, prevention is the best treatment. Fortunately, lifestyle changes are something the patient can work on themselves, in order to avoid the need for medication. If you had been diagnosed with PACs, book a massage or dedicate some time to one of your hobbies. At the same time, regular cardio exercise of moderate intensity can give your heart a push towards a regular, steady rhythm. From a physiologic standpoint, regular exercise is like a “natural” beta blocker!
Should I Worry or Not?
To sum it up, PACs are not a “dangerous” health condition by themselves. There is no need to worry if you happen to feel a “skipped” heartbeat from time to time – it’s a common thing that happens to all of us. You should be concerned if you notice rapid continuous beating or a constant irregular heartbeat. Those can be signs that the PACs may have triggered a more complex, potentially dangerous arrhythmia. If you have any doubts, discuss it with your doctor or request a referral to a heart rhythm specialist.
Sometimes, getting your heart checked and getting the advice of an experienced doctor may be all the treatment you need. Reassurance goes a log way, so you can enjoy your healthy lifestyle.