Does your heart suddenly skip a beat and feel like it's skipped a beat? Let's talk about (Premature Atrial Contractions)!

Have you ever felt like your heart suddenly skipped a beat, or suddenly felt like it was pounding inside your chest? Sometimes it's normal to feel a little scared and anxious when you feel something like this. But most of the time, it's nothing to be afraid of. Today, we're going to talk about this common condition that many people experience, namely Premature Atrial Contractions (PACs).

What are these Premature Atrial Contractions (PACs)?

To understand this simply, let's first take a look at how our heart works. Imagine that your heart is a small, but very powerful engine. For this engine to work properly, it needs to receive electrical signals in a systematic manner. In the upper two chambers of our heart (we call these ``Atria'' in medical terms), on the right side, at the top corner, there is a small place called ``Sinus node''. This is what works like the heart's natural 'pacemaker'. That is, it sends out electrical signals in a systematic manner that determine the rhythm and speed at which the heart should beat.

Now, Premature Atrial Contractions (PACs) are a small disruption to this normal process. Sometimes, an electrical signal is sent out prematurely from somewhere else in the upper chamber of the heart, not from the ``Sinus node''. The word ''premature'' means ''premature.'' So because of this premature signal, the heart beats once before its normal time.

Imagine, what happens here is like someone playing a drum while beating to the same rhythm, but suddenly hits it one time out of rhythm.

When the heart beats early, it can lose too much blood to pump through the heart at that time. So that premature beat is often weak. Then, the heart takes a short break for a few seconds and beats normally for the next beat. But because of that short break, the heart is filled with a little more blood when the next beat occurs. So that beat feels a little harder than usual. That hard beat is what we feel like we "missed a beat" or "like a pounding in the chest."

What are the symptoms of someone with PACs?

Some people may not experience any symptoms even though they have PACs. However, if they do, they may look like this. Let's look at this in a way that makes it clearer.

Why do we have these PACs? What are the reasons?

In most cases, there is no specific cause for PACs. However, there are several common factors that can contribute to the condition. Some of them are:

• Lifestyle factors:
• Caffeine overdose: Drinking too much of things like coffee, tea, and some soft drinks.
• Alcohol use: Drinking alcoholic beverages.
• Use of tobacco products: Things like cigarettes and drinks.
• Stress: Excessive anxiety, pressure.
• Fatigue and sleep deprivation: Feeling extremely tired and not getting enough sleep.
• Medical reasons:
• Mineral imbalance in the body:Decreased or increased levels of electrolytes, such as potassium or magnesium, in the blood.
• Structural heart problems: Conditions such as blockages in the blood vessels that supply blood to the heart (Coronary Artery Disease) or thickening of the heart muscle (Hypertrophic Cardiomyopathy).
• Damage to the heart: Due to a cause such as a previous heart attack.
• Thyroid problems: Changes in thyroid hormone levels.
• Certain medications: Some medications given for heart disease or mental illness.
• Illegal drug use.

If you have frequent PACs, your doctor will try to look for these causes.

Who is at higher risk of developing this condition?

Although PACs can occur in anyone, some people are at higher risk of developing them more frequently.

• Tall people
• Pregnant women
• People with cardiovascular disease
• People who are not physically active (those who do not exercise)
• People with high blood pressure (especially systolic pressure)
• People with diabetes
• People with low levels of good cholesterol (HDL cholesterol)
• People with chronic obstructive pulmonary disease (COPD)
• People who don't drink enough water
• People who smoke
• People who consume excessive amounts of caffeine or stimulants
• People who don't get enough sleep and are under a lot of stress

Are there any complications that can occur due to PACs?

PACs are usually harmless. However, if a person has PACs very often , it may be a sign of a more serious heart rhythm problem called `Atrial Fibrillation (Afib)` in the future.

Atrial Fibrillation (Afib) is a condition in which the upper chambers of the heart beat too fast and irregularly without control. This can lead to serious conditions such as stroke. That's why it's important to see a doctor if you're experiencing a lot of PACs.

How does a doctor diagnose this condition?

If you don't have any PACs when you go to the doctor, he or she may not be able to detect them with a stethoscope. Therefore, based on your symptoms, your doctor may recommend these tests.

How are PACs treated?

This is the most important thing: Most of the time, PACs don't require any treatment. They often go away on their own.

However, if your symptoms are very severe, or if PACs occur very frequently, your doctor may decide to treat you.

• Lifestyle changes: This is the first thing to try. Many people find relief by reducing caffeine and alcohol intake, quitting smoking, getting enough sleep, and managing stress.
• Medicines:
• Beta-blockers: This type of medication is the first choice. They reduce the heart rate and force of its contractions, controlling symptoms.
• Antiarrhythmics: Special medications that control the heart's rhythm. These are usually given only if beta-blockers cannot control it.
• Catheter ablation:This is done very rarely. In this, a thin tube (catheter) is inserted into the heart through the groin or arm, and a very small part of the heart that is emitting the abnormal electrical signals is destroyed.

Are there any side effects of the treatment?

Yes. As with any treatment, there are potential side effects. Beta-blockers can cause fatigue and dizziness. Anti-arrhythmic drugs have a variety of side effects, so they should be taken under close supervision by your doctor. Although catheter ablation is generally a low-risk procedure, there are very small risks, such as blood clots and bleeding.

What can I do to control PACs and reduce risk?

There are many things you can do to reduce and control your PACs.

• Exercise regularly .
• Limit caffeine-containing drinks like coffee, tea, and chocolate.
• Reduce or completely stop alcohol consumption.
• If you smoke, stop.
• Drink plenty of water. Avoid dehydration.
• Get enough sleep daily.
• Manage stress. Things like yoga and meditation can help.
• Control blood pressure and cholesterol levels.

When should I see a doctor?

Usually, if PACs occur occasionally, there is nothing to worry about. However, in such a case, you should definitely see your doctor.

• If your symptoms are getting worse.
• If the frequency of PACs increases.
• If these symptoms are accompanied by chest pain, severe shortness of breath, dizziness, or fainting, you should go to a hospital's Emergency Department (ETU) immediately.
• If you already have heart disease and develop PACs.

Some questions you may also have

Are PACs and Atrial Fibrillation (Afib) the same thing?

No. These are two different things. PACs are single, premature heartbeats. Afib is a serious condition in which the upper chambers of the heart beat in a completely irregular and rapid rhythm. However, having frequent PACs can increase the risk of developing Afib.

Is it something to be worried about when PACs develop during pregnancy?

Usually not. It is common for PACs to occur during pregnancy due to changes in hormones and blood volume. Most of the time, they go away on their own and do not require treatment. However, if you are concerned about this, talk to your doctor.

What is the difference between PACs and PVCs (Premature Ventricular Contractions)?

The difference is where the premature electrical signal starts. PACs start in the upper chambers of the heart (Atria) . PVCs start in the lower chambers of the heart (Ventricles) . The symptoms of both can be similar.