What is an ECTOPIC HEARTBEAT (Extrasystole)?

Ectopic heartbeats originate outside the normal pacemaker of the heart.

Therefore, an ectopic beat does not originate from the SA node (sino-atrial node; which is located in the right upper heart chamber; the SA node is the point from where electrical impulses are generated in the heart and conducted through the rest of heart muscle).

An ectopic beat originates from somewhere in the heart muscle, and not primarily from the SA node.

Why does this happen and how may it affect the patient’s health?

This condition may occur spontaneously in many instances but it may also be caused by

• Heartburn (acid peptic disease)
• Pregnancy
• Smoking
• An underlying disease
• Toxicity of certain medications such as digitalis

It may also present as a complication of heart valve and wall defects. In some instances it may result as a complication of a heart attack. It may be an early warning sign of a heart muscle that is deprived of oxygen; persistence of the condition may lead to a heart attack.

The character may indicate that the ectopic heartbeat originates from the muscles of the ventricles (lower heart chambers) or from the AV node and not from the SA node.

What symptoms may the patient experience?

• Patients may complain of experiencing heartbeats that are thumping in their chests; it may feel like a lot of fast heartbeats (palpitations)
• The patient may feel short of breath or have discomfort in the chest, which may also be as a result of the underlying cause for the ectopic heartbeats in the first place
• Patient may suffer from underlying heart failure, thrombo-embolic disease or ischaemic heart disease
• Ringing in ears
• Visual disturbances
• Swelling of legs

How is the diagnosis made and what special investigations are required?

An ECG will demonstrate abnormal ectopic heartbeats.

Arrhythmias need to be further evaluated and treated in order to
 

• Eliminate symptoms
• Prevent imminent death
• Offset the long-term risks of non life-threatening arrhythmias

What is the treatment and prognosis?

• Exercise is a very good way to get rid of ectopic heartbeats or to prevent it from reoccurring
• Stop smoking
• Avoid causative factors
• The main goals of treatment are to reduce symptoms, prolong life and treat any obvious underlying causes
• Specific medications will resolve the condition provided the causative underlying condition is taken care of

The prognosis depends on the underlying cause and whether it can be treated effectively.

Doctors first need to establish what type of arrhythmia they are dealing with in order to determine the following

• Is the arrhythmia causing symptoms?
• Is it a life-threatening problem?
• Does the arrhythmia need to be treated in hospital?
• What treatment is required?
• Must a cardiologist be consulted?

© 2003 Prometheus™ Healthcare (Pty) Ltd