Premature atrial contractions (PACs) are a common irregular heartbeat, or arrhythmia, involving an extra beat originating in the heart’s upper chambers, the atria. Often perceived as a “skipped” or “extra” beat, these occurrences are generally harmless and typically do not require specific medical intervention.
Understanding Premature Atrial Contractions
The heart normally maintains a steady rhythm, regulated by electrical impulses from the sinus node in the right atrium. A premature atrial contraction occurs when another area within the atria generates an electrical impulse earlier than the sinus node, causing the atria to contract prematurely. This early contraction briefly interrupts the heart’s normal rhythm.
Following this early beat, a brief pause often occurs before the next regular heartbeat, leading to the sensation of a “skipped” or stronger beat. Individuals may describe these sensations as fluttering in the chest or throat, or a general awareness of their heartbeat. While unsettling, isolated PACs are generally benign.
Common Triggers and Risk Factors
Lifestyle factors contributing to PACs include caffeine, alcohol, and tobacco. Stress, fatigue, insufficient sleep, and dehydration can also trigger them.
Certain medications, such as decongestants, asthma medications, and some heart or mental health drugs, may contribute to PACs. Underlying medical conditions also increase risk, including thyroid problems (like hyperthyroidism), electrolyte imbalances (low potassium or magnesium), and pre-existing heart conditions (high blood pressure, coronary artery disease, or heart failure).
When PACs Warrant Medical Attention
Certain symptoms or frequent occurrences of PACs warrant medical evaluation. Seek medical advice if PACs are accompanied by dizziness, lightheadedness, chest pain, or shortness of breath. A doctor should also be consulted if PACs become frequent (more than six times per minute or in groups of three or more) or significantly interfere with daily life.
Diagnosis of PACs involves a review of medical history and a physical examination. Doctors use an electrocardiogram (ECG) to record the heart’s electrical activity and detect premature beats. For intermittent PACs, a Holter monitor (worn for 1-2 days) or an event monitor (worn for up to 30 days) can provide a longer-term record of heart rhythms. Blood tests may also check for electrolyte imbalances or thyroid issues contributing to PACs.
Strategies for Managing PACs
Managing PACs involves several strategies, from lifestyle adjustments to medical interventions. If PACs are infrequent and do not cause significant symptoms, no specific medical treatment is necessary. In these cases, avoiding known triggers is key.
Lifestyle modifications include reducing caffeine, alcohol, and tobacco. Stress management techniques like meditation, yoga, or deep breathing can alleviate stress, a common PAC trigger. Adequate sleep, a balanced diet, and hydration also contribute to heart health and can reduce PAC frequency.
For symptomatic or frequent PACs, medical management may be considered. Beta-blockers are a first-line medication choice, regulating heart rhythm and reducing PAC frequency. Calcium channel blockers are another option, relaxing blood vessels and reducing the heart’s workload. In rare instances, for severe and persistent PACs significantly impacting quality of life, procedures like catheter ablation may target and eliminate the area causing premature beats.