Heart monitor gives 24-hour reading
DEAR DOCTOR: About 15 years ago, an EKG confirmed a heart irregularity, premature ventricular contractions. My doctor told me not to worry, and I’ve not had any problems. Now I’m 79 and still in good health, but my current doctor had me wear a heart monitor and has referred me to a cardiologist. Should I be concerned?
DEAR READER: Premature ventricular contractions (PVCs) are very common. In healthy people without any evidence of heart disease, 50-54 percent will be found to have some degree of PVCs when monitored for 24 hours.
Electrical impulses normally begin in the atria of the heart before they make their way down to the ventricles. This leads to the atria contracting first, followed by the ventricles. However, PVCs are ventricular contractions that bypass the atrial beat, leading to an extra heartbeat.
PVCs are more common in men than in women, increase in frequency with age and are more common in African-Americans. They are more common in people with structural heart disease, especially those with congestive heart failure and those who have had heart attacks.
Most PVCs are not felt. When patients feel PVCs, they often describe a sensation of a pause or a skipped beat.
People also sometimes feel that the heart is beating hard or fast or that they have a strong pulsation in the neck. Sometimes PVCs can cause lightheadedness and anxiety. Very frequent PVCs have been associated with heart failure.
Sometimes, concerns about PVCs are related to their frequency, especially if they were sporadic and then become more numerous. Increased frequency of PVCs has been associated with an increase in mortality.
The heart monitor that your doctor recommended should pick up the number of PVCs over a 24-hour period. If the PVCs are frequent, the cardiologist may want to do other studies, like an echocardiogram, to determine whether there is any structural damage to the heart.
Treatment of PVCs for people with symptoms include calcium channel blockers and beta blockers. If these don’t help control symptoms or if there is structural heart disease, anti-arrhythmic medication or electrical destruction of the area of heart that is causing PVCs may be necessary.