Episodic atrial precontractions are generally not a cause for undue concern, as many normal adults have atrial precontractions. Many normal adults have atrial presystole, which is present on an ambulatory electrocardiogram and generally occurs in less than 1000 normal adults. When atrial presystole is present, the patient must determine if there is a heart condition, such as coronary artery disease, cardiomyopathy, congenital heart disease, rheumatic heart disease, etc. If there is no specific type of heart disease, the patient does not need to be overly concerned. If recurrent episodes of atrial precontraction or even progression to atrial flutter or atrial fibrillation occur at a later stage, further drug therapy is required. Similar atrial presystole can occur in patients with underlying heart disease such as pulmonary hypertension, atrial septal defect, hyperthyroidism, or dilated cardiomyopathy.