What is the reason and treatment for extra heart beats?
Q: I am hypertensive since the age of 33 years. I was put on Atenolol 50 mg and TMT at that time was negative. It continued well until 2000 when Amlodepine 5mg was added and I continued taking it. Thereafter, I am given following medicines : Amlopress and Losar. Right now I am aged 45 years (Weight: 104 kg & height: 181 cms). I go for brisk walk. Low salt and diet restriction observed. Family History negative for IHD; Positive for HBP. My lipid profile is: Serum Cholestrol- 117; Triglycerides- 68; HDL- 35; LDL-67; VLDLC- 13; LDLC/HDLC 1.91 TC/HDLC 3.29. Thyroid Functions are normal; Non diabetic; Non smoker; Non alchohlic,; Non tobacco chewer. Kidney/liver functions normal. D-Echo: Mild MVP, Reduced LV Compliance; LVEF 60%. Tread Mill Test: Negative for exercise Induced Ischemia at moderate workload METS 11.4 : Exercise Time 10.03 Max speed : 4.2, Peak heart Rate: 201, Target rate 115, Good Exercise Tolerance, No angina/dysponea/arrhythmia noted; Normal Haemodynamic Response and test treminated due to fatigue. My chief problems : I have occasional VCP ventricular ectopia. Betablockers increased for this reason. I am Tachycardiac. Sometimes in moments of excitements, I get heaviness in chest. Feel occasional rise in BP in evening (around 145 to 150/90 to 95mm Hg). Is it necessary to adjust the dose? My job is full of stress and tension. As my HDL is poor, is it advisable to take statin? Your guidance and suggestions reagrding medicines/dose will be of immense help to me and I shall feel highly obliged.
A:Right at the outset, let me clarify that the advice we give is of generic nature and not having examined you, not everything that I am going to talk, is going to be specifically applicable to you. Taking up your points one by one: 1. Ventricular ectopics or extra beats are extremely common and may occur without any obvious heart disease. In any case, you have mitral valve prolapse which increases the chances of having missed beats. So one needs to do an echocardiography to make sure that there is no structural defect in the heart, other than mitral valve prolapse, and if not, then an occasional ventricular ectopic may not have to be treated but if they are more frequent, then beta blockers may suffice to control them. Even Holter test should be performed. 2. Your weight of 104 Kg for your height is definitely high and you should make every effort to reduce weight. This will not only help you cosmetically, but will also help reduce your blood pressure and the load on the heart as also may help your lipid profile. 3. Your HDL is very low, though rest of the lipid profile numbers are quite satisfactory. HDL can only be increased by regular exercises and Statins may not play a great role in increasing HDL. 4. Your blood pressure of 145-150 systolic and 90-95 mmHg diastolic is definitely high and needs to be brought down by at least 10-20mm Hg which can be done as already explained above, by regular exercises, losing weight, control of stress and strain and if the above measures do not help, then recourse to medications. 5. Also you must have regular executive health check done which includes a 2D Echocardiography and Treadmill test. This check should be done once in two years till the age of 60 years and thereafter it should be once in a year. Needless to say if there is any abnormality found in this executive health check, they need to be followed up in the own merit. I hope I have answered your queries to your satisfaction but if you still have any doubts, please feel free to contact us and it shall be our pleasure to answer them.