Are premature beats life-threatening?

Question

Hello doctor,

I am a 48-year-old male with a lean build, and I exercise regularly. Since childhood, I have had a tendency toward heart palpitations and premature beats, mostly when I do not get good sleep or when I am experiencing stress. Around 16 years ago, I consulted a cardiologist and underwent an ECG and echocardiogram. Both tests were normal, and the doctor indicated that there was no heart problem; the symptoms were attributed to anxiety. Since then, the palpitations have reduced significantly, and I only experience premature beats occasionally.

Four days ago, I did not sleep well the previous night, and in the afternoon, I had a very heavy lunch at work. After that, when I walked a short distance, I felt as though I was experiencing premature beats. This sensation subsided after four to five minutes. When I returned to my office, I felt the same sensation again. However, in the evening, I was perfectly fine when I got home, even walking up three flights of stairs without any issues.

The next day, I did my regular exercise routine, which included some running, without any problems. A day later, after only four hours of sleep, I had to go to work. In the evening, I had some beer, after which I experienced premature beats again, but they subsided after five minutes. For the last two days, I have not had any issues at all. There were no other symptoms during these episodes. My blood pressure is consistently normal, as I have it checked regularly. I have no other medical conditions to date, except for a tendency to worry about my health.

Please guide me.

Answer 1

Hello,

Welcome to icliniq.com.

These premature complexes are likely originating from the ventricles. They are usually benign and not life-threatening. Considering your age, the primary concern would be coronary artery disease; however, this is less likely since you have been experiencing these symptoms since childhood and do not have any of the other key symptoms associated with it. Factors such as lack of sleep, stress, alcohol, smoking, and caffeinated beverages are well-known triggers for sympathetic overactivity.

I suggest the following: you should undergo a treadmill test to rule out coronary artery disease. An echocardiogram should also be repeated to ensure that your heart is functioning properly. Additionally, a thyroid test should be conducted. If you are currently smoking, consuming alcohol, or using caffeinated products, I recommend that you avoid them.

While we do not need to treat these premature beats unless they are troubling you, you can consider taking Metoprolol XR 25 mg once a day if your pulse rate is over 70. This medication can help suppress these beats and relieve your symptoms. Overall, this is not a worrisome matter, and getting the investigations done is a matter of personal choice.

I hope this information is helpful.

Please feel free to reach out if you have any questions.