Ms. Li, 30 years old, is a police officer, recently the unit for physical fitness test, relatively tired, feel sometimes the heart will thump, as if suddenly stepped on the empty foot, the heart suddenly stopped beating, pulse stopped beating a few times, very nervous, rushed to the hospital for consultation, did an electrocardiogram, found to be premature beats. Mr. Shen, 48 years old, has premature ventricular contractions, with more than 20,000 electrocardiograms in 24 hours, and he often feels tightness in his chest when he has many premature contractions and needs to breathe deeply. We often see such patients in outpatient clinics, who usually do not have any discomfort but are told by the doctor during the physical examination that they have premature beats. Because they don’t know what premature beats are, they are often very nervous and even anxious, fearing that they have a heart attack. What kind of disease is premature beats? Is it a heart attack? How to deal with it? 1. What is premature beats? The human heart is a pumping organ that pumps blood rhythmically with one beat after another to supply the metabolic needs of the human organs. The origin of the heart’s electrical activity is the sinus node. In a normal adult at rest, the sinus node regularly sends out 60-100 electrical impulses per minute to the entire heart, which is the “sinus rhythm” we often see on electrocardiogram reports. If heart tissue other than the sinus node controls the electrical activity of the heart, the heart may contract once before it is fully filled with blood, a condition we call a prolonged contraction or premature beat. If the beat is generated in the ventricle, it is a ventricular premature beat; if it is generated in the atrium, it is an atrial premature beat. 2. Are premature beats equal to heart disease? It is wrong to say in general that premature beats are equal to heart disease. Some rumors, such as ventricular premature beats are more dangerous than atrial premature beats and may lead to sudden death, are even more nonsensical. Although premature beats are irregular heartbeats, they are not always caused by disease. If a normal person is continuously observed with an electrocardiogram for 24 hours, premature beats can be recorded in about 60% of people. It is well documented that almost all people experience premature beats during their lifetime, and that they tend to increase with age, although many do not feel them. Therefore, clinicians classify premature contractions into two main categories: those that are not associated with heart disease, which we call benign premature contractions. They occur in cases of emotional stress, nervousness, fatigue, menopause, indigestion, excessive smoking, alcohol consumption, or stimulating cooking materials such as strong tea and coffee. Another type of premature beats is when there is a combination of heart disease. It mostly occurs in coronary heart disease, hypertension, myocarditis, cardiomyopathy, mitral valve disease, hyperthyroid heart disease, etc. For example, some people attribute premature beats in young people and children to myocarditis, but when there is no evidence of myocarditis, they attribute them to “post-myocarditis”. Premature beats in the elderly are attributed to coronary artery disease. This kind of speculative diagnosis makes a large number of patients with good prognosis of benign premature beats unable to work and live normally for a long time, losing their beloved career and family happiness, and even missing their life. What is the prevention and treatment of premature beats? Patients with premature beats should go to the hospital for examination to determine whether they have heart disease. The available examinations include medical consultation and physical examination, chest X-ray, echocardiography and exercise test ECG. If no organic heart disease is found, these premature beats are benign. Many patients with premature beats have no conscious symptoms and are usually in good health, but their premature beats are discovered unintentionally during education, employment or medical examinations. These patients’ premature beats are usually benign and do not require treatment. As mentioned at the beginning of the article, Officer Li was found to have benign premature contractions after examination. The effect of benign premature beats on people is minimal, and they generally do not develop or cause other heart diseases, nor do they increase the risk of cardiac death, and the prognosis is good. The prognosis is good. The main thing to avoid is triggering factors such as smoking, coffee, excessive fatigue and stress. If the patient’s symptoms are not obvious, benign premature beats can be left untreated, but if they have a great impact on the patient’s life, some medications can be used under the guidance of the doctor to control them properly. In fact, there is no drug that can completely suppress premature beats, and there is no need for long-term or even lifelong medication for benign premature beats, and medication can have side effects. Generally speaking, as long as people with premature beats feel tolerable, they can go on with their normal life and carry out their normal daily work without any psychological burden. Many patients with benign premature beats keep touching their pulses every day, and the more they touch them, the more nervous they become. In fact, there is no inevitable connection between the number of premature beats and heart disease. Many doctors or patients repeatedly use the costly 24-hour ambulatory ECG records to analyze the number of premature beats, and do not properly understand the significance of premature beats, which not only wastes medical resources but also increases the mental burden of patients. For premature beats combined with heart disease, treatment is often needed, and this treatment is firstly for the original heart disease, for example, if there is coronary heart disease and the blood supply to the heart is bad, the problem of blood supply to the heart should be solved first; for example, if premature beats are caused by hyperthyroid heart disease, the hyperthyroidism should be controlled first. Some anti-arrhythmic drugs are sometimes used for premature beats, but they should be administered under the guidance of an experienced cardiovascular specialist, and long-term medication for premature beats is not recommended, because studies have found that all drugs for arrhythmias have the effect of causing new arrhythmias and may increase the risk of mortality and sudden death. Some patients with symptomatic premature beats, who cannot tolerate medication and the effect of medication is not good, can use radiofrequency ablation to eliminate premature beats with a success rate of about 90%, but the procedure is more expensive and there are some surgical risks. Mr. Shen was found to have more than 20,000 ventricular premature beats in 24-hour ECG test, and no organic heart disease was found after examination in our hospital. After psychological counseling to eliminate anxiety, and a short period of time to take anti-arrhythmic drugs, the symptoms were still poorly controlled. Using radiofrequency ablation, Mr. Shen’s premature ventricular contraction was completely cured. In conclusion, most people have premature beats, including normal people. The key is to find out the nature of premature beats: benign or pathological. Benign premature beats generally do not require treatment, avoiding the triggers that cause them; while pathological premature beats should be treated first for the underlying heart disease. Anti-arrhythmic drugs are rarely used for premature beats to avoid unnecessary side effects.