In Foucs: A Brief Overview of Premature Atrial Contractions
The sinus node is a heart’s natural pacemaker situated in the upper part of the wall of right atrium. It is a collection of cells which generates electrical impulses and causes contraction. Premature atrial contractions (PACs) are the most common form of arrythmias which occur due to an ectopic focus within the atria that generates extra heart beat. The usual pattern is, a heartbeat earlier than the normal beat followed by a pause and then a stronger second beat. It is called premature because it occurs before a normal beat.
Premature Atrial Contractions (PACs) are common in normal population and do not require any treatment. These are called asymptomatic while symptomatic Premature Atrial Contractions on the other hand can be problematic. They occur due to many reasons like myocardial ischemia, anxiety, excess caffeine, alcohol intake, poor sleep etc and should be treated by correcting the underlying condition. It is also common in people with lung disorders and more common in older people than in young.
In Premature Atrial Contractions (PACs), the patient may complain of palpitations and a sense that heart has skipped a beat, but in reality, the heart doesn’t skip a beat. What actually happens is that because the beat occurs prematurely heart does not get filled up properly and thus it pumps reduced amount of blood which gives a sense of skipped beat. Mostly this occurs at night and when a person is at rest.
Premature Atrial Contractions (PACs) may be unifocal or multifocal. In unifocal PACs there is only one ectopic focus in which p waves are identical ,while in multifocal PACs two or more ectopic foci are present with different patterns of p waves. Also they can occur in repeating patterns: like bigeminy, in which PAC occurs after every single beat; trigeminy, in which PAC occurs after every two beats; quadrigeminy, in which PAC occurs after every 3 beats; couplet, in which 2 premature beats occur consecutively; and triplet, in which 3 premature beats occur consecutively.
Premature Atrial Contractions (PACs) are investigated during physical examination and confirmed by electrocardiography, which shows abnormal p wave followed by a normal QRS complex. The first line treatment is reassurance. Beta blockers may be given which decrease the sensation of PACs. For extremely symptomatic patients antiarrythmatic drugs like flecainide and propafenone are given to control rhythm of heart.
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