Overview
Atrial pre-systole is a premature beat that originates anywhere in the atria other than the sinus node.
It is mainly characterized by palpitations, which may be accompanied by a feeling of cardiac arrest.
It may be associated with disease, medication, etc.
Asymptomatic patients do not require treatment; patients with obvious symptoms or other tachyarrhythmias may be treated with medications.
Definition
Atrial preterm contraction, also known as atrial premature beat, is a condition that originates in the sinus node.
It is a common clinical arrhythmia and is mostly functional, but can also occur in organic heart disease.
Classification
Patients are categorized according to the presence or absence of underlying cardiac pathology
Non-organic atrial pre-systole: no cardiac pathology, induced by mental stress, overwork and excessive smoking, alcohol and coffee.
Organic atrial pre-systole: there is a lesion in the heart itself, which affects the rhythm of the atrial beat and causes atrial pre-systole.
Classification according to the frequency of attacks
Occasional atrial pre-systole: the frequency is less than or equal to 5 times per minute.
Frequent atrial pre-systole: more than 5 times per minute.
Episodes
Atrial pre-systole occurs in about 60% of healthy adults who undergo a 24-hour ambulatory electrocardiogram. It is rare in children and more common in middle-aged and elderly people.
Etiology
Causes
Disease Factors
Organic heart disease such as coronary atherosclerotic heart disease (coronary artery disease), mitral valve lesions, cardiomyopathy, myocarditis, mitral valve prolapse, and heart failure.
Abnormal thyroid function, especially hyperthyroidism, adrenal disease.
Electrolyte disorders, such as hypokalemia, hypomagnesemia, hypocalcemia.
Medical factors
Such as after performing heart surgery or cardiac catheterization.
Pharmacologic factors
Digitalis, antimony, quinidine, sympathomimetic drugs (epinephrine, norepinephrine, etc.), chloroform, cyclopropane anesthetics, etc.
Triggering factors
Emotional excitement, nervous tension, excessive fatigue, anxiety.
Excessive smoking and drinking for a short period of time.
Drinking large quantities of strong tea or coffee in a short period of time.
Symptoms
Main Symptoms
No obvious symptoms: there may be no obvious symptoms when atrial pre-systolic episodes are infrequent.
Palpitations: may occur when atrial pre-systole occurs frequently and may be accompanied by a feeling of cardiac arrest, etc.
Others: there may be chest tightness, discomfort in the precordial area, weakness, and intermittent pulse.
Complications
Atrial preterm contraction does not usually have complications if there are no other heart lesions.
With the aggravation of underlying heart disease, atrial pre-systole may increase the frequency of attacks and even induce atrial tachycardia or even atrial fibrillation. In severe cases, malignant arrhythmia may occur, which may be manifested as fainting, convulsions or even cardiac arrest.
Consultation
Department of Medicine
Cardiovascular Medicine
Routine physical examination reveals abnormal electrocardiogram results, or symptoms such as fatigue, palpitations, dizziness, etc., it is recommended to go to the Department of Cardiovascular Medicine for timely consultation.
Emergency Medicine
Sudden and severe palpitations and dyspnea, etc., it is recommended to go to the Emergency Department immediately.
In case of loss of consciousness, respiratory and cardiac arrest, immediately call 120 emergency and perform CPR on the patient at the same time.
Preparation
Preparing for your visit: registration, information preparation, common problems
Tips for medical treatment
Some atrial preterm contractions may be occasional and no ECG abnormality may be detected during the examination. You can always record the triggering factors before the onset of symptoms to facilitate the doctor’s diagnosis.
Preparation List
Symptom list
Particular attention should be paid to the time of onset of symptoms, special manifestations, etc.
Are there any triggers, duration, and relief methods for palpitations, chest tightness, and heart “stopping” and “sudden movement” episodes?
What parts of the body are uncomfortable at the onset of the attack, and are there any dizziness, palpitations, dyspnea, chest pain, chest tightness, edema, or syncope?
List of medical history
Is there any history of heart disease?
Have you recently stayed up late, overworked, or consumed large quantities of strong tea or coffee?
Any recent cases of large mood swings, severe anxiety, irritability, etc.?
Have you visited other hospitals or clinics, what tests have been done, what medications have you taken, and has your condition improved?
Checklist
Test results in the past six months, which can be brought to the doctor’s office
Laboratory tests (routine blood tests, liver and kidney function, blood lipids, coagulation, markers of myocardial injury, brain natriuretic peptide, thyroid function measurement, etc.)
Electrocardiogram (including routine electrocardiogram, 24-hour ambulatory electrocardiogram, etc.)
Echocardiography
Coronary angiography
Diagnosis
Diagnostic basis
Medical history
History of heart disease, endocrine disease, etc.
Recent history of heavy drinking and smoking.
History of drug use such as digitalis, quinidine and cyclopropane.
Clinical manifestations
The main manifestation is palpitations, which may be accompanied by a feeling of cardiac arrest.
Laboratory tests
Routine blood tests: can determine the presence of infection, helpful in determining the presence of bacterial endocarditis or concomitant infection.
Electrolyte tests: Abnormal serum potassium levels can lead to arrhythmias, especially if drugs such as digoxin are being taken.
Myocardial necrosis marker test: can rule out myocardial infarction.
Electrocardiogram
It can be used to understand the occurrence and conduction of the electrical activity of the heart by recording the waveform changes of the electrical activity of the heart.
ECG is one of the main tests to confirm the diagnosis of preterm systole and can also detect other cardiac pathologies.
Precautions: ECG is a non-invasive test, so be careful to cooperate with the doctor in exposing the chest during the test.
24-hour ambulatory electrocardiogram (Holter test)
An ambulatory electrocardiogram (ECG) is mainly used to assess the number of occurrences of atrial preterm contractions and when they occur, and helps to determine the cause and severity of atrial preterm contractions.
Precautions
After wearing the ECG machine, patients can maintain their usual daily activities and do not need to deliberately reduce the amount of exercise.
When moving around, the upper limbs should avoid exerting themselves or making large movements, so as to avoid the device slipping off.
Do not take a bath or swim during the examination to avoid liquid entering the instrument and affecting the results.
When the patient experiences discomfort during the whole examination process, the patient and family members should record the time of the beginning and end of the symptoms and the triggers, so as to provide more references for the doctor’s diagnosis.
Imaging
Echocardiography
To assess the structure, function and valves of the heart.
Precautions
Expose the chest as requested by the doctor before the examination.
A coupling agent will be applied to the skin at the examination site.
Keep your position and avoid moving around during the examination as requested by your doctor.
The coupling agent can be wiped off with tissue paper after the examination.
Coronary Angiography
To find out if coronary artery disease exists and to determine the severity of the disease.
Precautions
Before the examination, you must clearly inform the doctor of your previous illnesses and medications you are taking, and stop using certain medications as requested by the doctor.
Lie down as requested by the doctor during the examination and avoid moving around. Inform the doctor promptly if you feel unwell.
Move around as requested by the doctor after the examination and avoid excessive movement of the puncture site, such as the wrist and thigh root.
Inform your doctor if there is bleeding or increasing pain at the puncture site after the test.
Cardiac magnetic resonance examination
To determine whether the patient has dilated cardiomyopathy, hypertrophic cardiomyopathy, amyloidosis and other heart lesions.
Precautions
Remove items containing metal, as well as earrings, keys, electronic devices, etc. before the examination.
If there are medical devices such as steel plates and implantable pacemakers in the body, the doctor should be informed in advance.
Differential Diagnosis
Atrial preterm contraction can usually be diagnosed on the basis of an electrocardiogram and does not need to be differentiated from other diseases.
Treatment
Asymptomatic patients usually do not require treatment. When symptoms become evident or induce other tachyarrhythmias, treatment should be prompt. In the presence of organic disease, the primary disease should be treated aggressively.
General treatment
Elimination of triggers: such as mental tension, emotional excitement, excessive fatigue, anxiety, smoking, drinking alcohol, avoiding strong tea, coffee, etc.; when anxiety is severe, referral to the Clinical Psychology Clinic can be made.
Discontinue the use of related drugs: If the drug is caused by the drug factor, discontinue the use of related drugs or follow the doctor’s instructions to change the drug.
Actively treat the primary disease: correct the electrolyte disorder, heart failure, hyperthyroidism and other primary underlying diseases.
Drug treatment
Antiarrhythmic drugs can be used if the symptoms are severe.
Commonly used drugs: β-blockers (propranolol, atenolol, etc.), non-dihydropyridine calcium channel antagonists (such as diltiazem).
Catheter-based radiofrequency ablation
Indications: Catheter ablation can be used for more frequent episodes of preterm systole that are ineffective with medication and accompanied by obvious symptoms such as panic attacks and chest tightness.
Post-operative care
After the operation, patients should follow the doctor’s instructions to stay in bed and rest, and the puncture site should be restricted from moving for 8 to 12 hours.
Patients and their family members should closely observe the condition of the dressing at the puncture site and contact the doctor promptly if there is fever, blood seepage or hematoma.
If chest tightness or chest pain occurs after surgery, please contact the doctor immediately.
Prognosis
Cure
Asymptomatic patients usually do not require treatment and regular review is sufficient.
After treatment, the prognosis is generally good.
The prognosis for those with other diseases depends on the severity of the original disease.
Prognostic factors
The most important prognostic factor affecting the prognosis of atrial pre-systole is whether it is associated with organic heart disease, and the prognosis is usually good for patients who do not have organic heart disease.
The prognosis for patients without organic heart disease is usually good. For patients with organic heart disease, the prognosis varies depending on the type and severity of their heart disease.
Hazards
It may cause discomfort such as panic attacks.
If combined with organic heart disease, the frequency of atrial pre-systolic episodes increases and may develop into atrial tachycardia and other disorders if left untreated.
Daily
Daily management
Dietary regulation
Eat more green vegetables, fresh fruits, high-calcium and potassium-containing foods, and try to choose fruits with low sugar content and low calories.
Avoid excessive intake of salt, e.g. eat less pickled and processed food.
Avoid excessive intake of animal offal rich in saturated fatty acids, margarine and fatty meat.
Do not eat too much.
Lifestyle Habits
Avoid drinking strong tea and coffee, etc.
Quit smoking and drinking.
Ensure reasonable sleep time.
Exercise and strengthen your body.
Mood adjustment
Avoid excessive stress.
Positively adjust the bad mood and keep a good mindset.
Follow-up and review
For patients with organic heart disease, they should be examined every 6 months, and the examination includes electrocardiogram and echocardiogram.
Prevention
Actively treat the primary disease, such as infection, hyperthyroidism, myocarditis, coronary heart disease, hypertension, etc.
Avoid the use of drugs that can cause this disease, or strictly follow the doctor’s instructions, and promptly consult the doctor when discomfort occurs.
Quit smoking and avoid passive smoking.
Maintain a positive state of mind, avoid tension, anxiety, anger and other bad emotions.
Improve living habits, insist on moderate exercise, ensure adequate sleep, avoid exertion and staying up late.
Have regular medical checkups, and seek timely medical treatment when abnormalities are detected.